River City Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

RIVER CITY DENTAL, LLC

Practice address

1201 Maine Prairie Rd
Saint Cloud, MN 56301-4881

Phone

(320) 252-6233

Fax

(320) 252-9261

NPI assigned

Nov 8, 2006

Organization subpart

No

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

Authorized official

Name

Dedric McBroomNPI 1871663914

Title

Owner

Phone

(320) 252-6233

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dedric Rolf McBroom, D.D.S.

  • General Practice Dentistry
  • Saint Cloud, MN
  • NPI 1871663914
  NPD (past) Authorized official
• Aaron Daniel Imdieke, D.D.S.

  • General Practice Dentistry
  • Saint Cloud, MN
  • NPI 1124198254
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356411417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563020280",
            "telephone_number": "320-252-6233",
            "fax_number": "320-252-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 MAINE PRAIRIE RD",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014881",
            "telephone_number": "320-252-6233",
            "fax_number": "320-252-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER CITY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCBROOM",
        "authorized_official_first_name": "DEDRIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-252-6233"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riseup Transport LLC
• Kirstin Risgaard, MS, LCGC
• Rising Homes Inc
• Rising Up, LLC
• Nyanom Rial Rith
• River Haven Family Counseling
• Stacy Rivers, LICSW
• Riverside Behavioral Health LLC
• Lois Schueller Roback, MSW/LISW
• Hedy Robben, RBT

• General Practice Dentistry in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.