Provider Demographics
NPI:1457310633
Name:RIVERA, OMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:HC-71 BOX 3278
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00719
Mailing Address - Country:UY
Mailing Address - Phone:787-870-5225
Mailing Address - Fax:
Practice Address - Street 1:BO QUEBRADILLAS
Practice Address - Street 2:CARR 152 KM 7.6
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-370-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice