Provider Demographics
NPI:1083784474
Name:RIVERA, CARMEN G (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:G
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 LUNA ST.
Mailing Address - Street 2:APT. C2
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-0901
Mailing Address - Country:US
Mailing Address - Phone:787-725-6280
Mailing Address - Fax:
Practice Address - Street 1:251 LUNA
Practice Address - Street 2:APT. C2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-0901
Practice Address - Country:US
Practice Address - Phone:787-725-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist