Provider Demographics
NPI:1073921706
Name:RIVAS, STEPHANY (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:
Other - Last Name:RIVAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:634 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3012
Mailing Address - Country:US
Mailing Address - Phone:408-288-5490
Mailing Address - Fax:
Practice Address - Street 1:634 N 13TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3012
Practice Address - Country:US
Practice Address - Phone:408-288-5490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist