Provider Demographics
NPI:1114146768
Name:RIVERA, PAUL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 WHITNEY WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3224
Mailing Address - Country:US
Mailing Address - Phone:512-914-7954
Mailing Address - Fax:
Practice Address - Street 1:720 BRAZOS ST STE 118
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2536
Practice Address - Country:US
Practice Address - Phone:512-478-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist