Rivers Edge Dental Clinic, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

RIVERS EDGE DENTAL CLINIC, PLLC

Practice address

16023 Elmhurst LN Ste 104
Lakeville, MN 55044-4791

Phone

(952) 232-6454

Fax

(651) 460-6123

NPI assigned

Aug 15, 2018

Organization subpart

Yes

Parent organization

RIVERS EDGE DENTAL CLINIC, PLLCAs reported in NPPES

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

Authorized official

Name

Dr. Jessica Ann Tri, DDS

Title

Owner

Phone

(952) 232-6454

Specialties & licenses 1

Addresses

Part of

Rivers Edge Dental Clinic PLLC

Locations

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

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534291200000",
    "number": "1750861258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16023 ELMHURST LN STE 104",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550444791",
            "telephone_number": "952-232-6454",
            "fax_number": "651-460-6123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16023 ELMHURST LN STE 104",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550444791",
            "telephone_number": "952-232-6454",
            "fax_number": "651-460-6123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERS EDGE DENTAL CLINIC, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERS EDGE DENTAL CLINIC, PLLC",
        "enumeration_date": "2018-08-15",
        "last_updated": "2018-08-15",
        "status": "A",
        "authorized_official_last_name": "TRI",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-232-6454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; 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.