Provider Demographics
NPI:1275973216
Name:RIVERA, CAROLINA BERENICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:BERENICE
Last Name:RIVERA
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 1:528 FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-4212
Mailing Address - Country:US
Mailing Address - Phone:504-352-4334
Mailing Address - Fax:
Practice Address - Street 1:2960 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4153
Practice Address - Country:US
Practice Address - Phone:985-641-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA64031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice