Provider Demographics
NPI:1457484206
Name:DIEGO E. RIVAS DDS PA CORPORATION
Entity Type:Organization
Organization Name:DIEGO E. RIVAS DDS PA CORPORATION
Other - Org Name:HUEBNER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-697-3500
Mailing Address - Street 1:9820 HUEBNER RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3265
Mailing Address - Country:US
Mailing Address - Phone:210-697-3500
Mailing Address - Fax:210-697-3505
Practice Address - Street 1:9820 HUEBNER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3265
Practice Address - Country:US
Practice Address - Phone:210-697-3500
Practice Address - Fax:210-697-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty