Provider Demographics
NPI:1376664763
Name:RICHARD D RIVA DDS LLC
Entity Type:Organization
Organization Name:RICHARD D RIVA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEONS
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-635-5800
Mailing Address - Street 1:33 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928
Mailing Address - Country:US
Mailing Address - Phone:973-635-5800
Mailing Address - Fax:973-635-5383
Practice Address - Street 1:33 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928
Practice Address - Country:US
Practice Address - Phone:973-635-5800
Practice Address - Fax:973-635-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI010299001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI01029900OtherB OF DENTISTRY LICENSE #
NJ22DI01029900OtherB OF DENTISTRY LICENSE #
NJ072695Medicare PIN