Provider Demographics
NPI:1114104510
Name:MARILYN RIVERO KOUTRAKIS
Entity Type:Organization
Organization Name:MARILYN RIVERO KOUTRAKIS
Other - Org Name:MARILYN RIVERO D.M.D., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO KOUTRAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-872-4848
Mailing Address - Street 1:235 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702
Mailing Address - Country:US
Mailing Address - Phone:508-872-4848
Mailing Address - Fax:508-872-4849
Practice Address - Street 1:235 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-872-4848
Practice Address - Fax:508-872-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty