Provider Demographics
NPI:1275229296
Name:RIVERA & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:RIVERA & ASSOCIATES, P.A.
Other - Org Name:WIRY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF BUSINESS OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-406-2921
Mailing Address - Street 1:3340 ROBINWOOD RD STE 100-406
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6689
Mailing Address - Country:US
Mailing Address - Phone:719-406-2921
Mailing Address - Fax:704-398-7373
Practice Address - Street 1:1819 BRENNER AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2519
Practice Address - Country:US
Practice Address - Phone:704-944-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERA & ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty