Provider Demographics
NPI:1245386713
Name:RIVAS, JOSEFA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEFA
Middle Name:A
Last Name:RIVAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 47TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5225
Mailing Address - Country:US
Mailing Address - Phone:718-482-8065
Mailing Address - Fax:718-482-8066
Practice Address - Street 1:4527 47TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5225
Practice Address - Country:US
Practice Address - Phone:718-482-8065
Practice Address - Fax:718-482-8066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050748-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice