Provider Demographics
NPI:1124029723
Name:RIVERA, MIGUEL EFRAIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:EFRAIN
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 CALLE CELIS AGUILERA
Mailing Address - Street 2:P O BOX 266
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-2528
Mailing Address - Country:US
Mailing Address - Phone:787-845-3071
Mailing Address - Fax:
Practice Address - Street 1:69 CALLE CELIS AGUILERA
Practice Address - Street 2:PLAZA DEL PARQUE # 3
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2528
Practice Address - Country:US
Practice Address - Phone:787-845-3071
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
41128OtherTRIPLE S
2696OtherINTERNATIONAL MEDICAL CAR
7570021OtherHUMANA
206605OtherPREFERRED HEALTH
PR040694OtherLA CRUZ AZUL