Provider Demographics
NPI:1124368139
Name:RIVERA HENRANDEZ, XIOMARA YOLANDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:XIOMARA
Middle Name:YOLANDA
Last Name:RIVERA HENRANDEZ
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:PASEOS LOS CORALES I #593 ST. MAR INDICO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4514
Mailing Address - Country:US
Mailing Address - Phone:787-414-6354
Mailing Address - Fax:
Practice Address - Street 1:1600 WILSON BLVD STE 960
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2509
Practice Address - Country:US
Practice Address - Phone:703-465-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014158171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program