Provider Demographics
NPI:1548535040
Name:RIVER POINTE DENTAL OF HUNTLEY
Entity type:Organization
Organization Name:RIVER POINTE DENTAL OF HUNTLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:DYANE
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-515-8600
Mailing Address - Street 1:12080 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7654
Mailing Address - Country:US
Mailing Address - Phone:847-515-8600
Mailing Address - Fax:
Practice Address - Street 1:12080 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7654
Practice Address - Country:US
Practice Address - Phone:847-515-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19025215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty