Provider Demographics
NPI:1275888281
Name:RIVERA, ELIAS M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 GARRISONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-3710
Mailing Address - Country:US
Mailing Address - Phone:540-300-1248
Mailing Address - Fax:
Practice Address - Street 1:623 GARRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3710
Practice Address - Country:US
Practice Address - Phone:540-300-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014172691223P0700X
MD172141223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics