Provider Demographics
NPI:1275791246
Name:RIVERA, GEORGE (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
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 1:17W535 BUTTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4010
Mailing Address - Country:US
Mailing Address - Phone:630-592-4949
Mailing Address - Fax:877-334-0705
Practice Address - Street 1:17W535 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4010
Practice Address - Country:US
Practice Address - Phone:630-592-4949
Practice Address - Fax:877-334-0705
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190191161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice