Riverside Dentistry PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

RIVERSIDE DENTISTRY PLLC

Practice address

207 W Main St
Lowell, MI 49331-1607

Phone

(616) 897-7179

Fax

(616) 897-7189

NPI assigned

Oct 12, 2022

Organization subpart

No

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

Authorized official

Name

Min Suk Han, DDSNPI 1386026094

Title

Owner

Phone

(734) 730-2963

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Min Suk Han, D.D.S.

  • General Practice Dentistry
  • Lowell, MI
  • NPI 1386026094
  NPD Authorized official
• James Edward Reagan, DDS

  • General Practice Dentistry
  • Lowell, MI
  • NPI 1184832206
  NPD (past)

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668297600000",
    "number": "1518682541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 ABBEY MILL CT SE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493017714",
            "telephone_number": "734-730-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 W MAIN ST",
            "city": "LOWELL",
            "state": "MI",
            "postal_code": "493311607",
            "telephone_number": "616-897-7179",
            "fax_number": "616-897-7189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-11-13",
        "certification_date": "2022-11-13",
        "status": "A",
        "authorized_official_last_name": "HAN",
        "authorized_official_first_name": "MIN SUK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-730-2963",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Retirement Living Management of Lowell (Green Acres Lowell)
• Retirement Living Management of Standale L.L.C (Green Acres of Standale)
• Adam David Rhoda, P.T., D.P.T.
• Emily Anne Rienks
• Rite Aid of Michigan Inc (Rite Aid Pharmacy 01529)
• Sherry Rodriguez
• Eric Rottman
• Makayla Jennifer Rozelle, COTA/L
• Izabel Rutz
• McKenzi Jane Sall

• General Practice Dentistry in Lowell, MI
• Providers in Lowell, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2022; 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.