Riverside Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN 12242 Issued in FL

Legal business name

RIVERSIDE DENTAL

Practice address

9402 N US Highway 1
Sebastian, FL 32958-6398

Phone

(772) 589-1140

NPI assigned

Sep 13, 2007

Last updated

Sep 13, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Louis R Roque, D.D.S.

Title

Dentist

Phone

(772) 589-1140

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1306031281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9402 N US HIGHWAY 1",
            "city": "SEBASTIAN",
            "state": "FL",
            "postal_code": "329586398",
            "telephone_number": "772-589-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9402 N US HIGHWAY 1",
            "city": "SEBASTIAN",
            "state": "FL",
            "postal_code": "329586398",
            "telephone_number": "772-589-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "ROQUE",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "772-589-1140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "FL",
            "license": "DN 12242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila Richard, CST, CSFA
• Kelli Marie Rike
• Jose David Rivera-Jimenez, MD
• Mary Elizabeth Rivero
• Rivers Edge DPC Inc
• Riverside Dental Arts PLLC
• Riverside Eye Center PLLC (Riverside Eye Center)
• Riverside Family Dental, P.a.
• Riverside Surgery Center Inc
• Riverside Surgical and Weight Loss Center,LLC

• Dental Clinic/Center in Sebastian, FL
• Providers in Sebastian, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.