Provider Demographics
NPI:1033320759
Name:RIVERA, NOEL C (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:C
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 BLACKPOOL LN
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6004
Mailing Address - Country:US
Mailing Address - Phone:510-381-2679
Mailing Address - Fax:510-568-3577
Practice Address - Street 1:1375 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2917
Practice Address - Country:US
Practice Address - Phone:510-582-8277
Practice Address - Fax:510-582-0305
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA481741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice