Provider Demographics
NPI:1093044539
Name:MELISSA RIVERA DDS PA
Entity Type:Organization
Organization Name:MELISSA RIVERA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-787-9866
Mailing Address - Street 1:4500 N RAUL LONGORIA
Mailing Address - Street 2:PO BOX 186
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-0186
Mailing Address - Country:US
Mailing Address - Phone:956-787-9866
Mailing Address - Fax:956-787-8588
Practice Address - Street 1:4500 N RAUL LONGORIA STREET
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-787-9866
Practice Address - Fax:956-787-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty