Provider Demographics
NPI:1528567765
Name:RIVAS, ELSA NIDIA (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:NIDIA
Last Name:RIVAS
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:MS
Other - First Name:ELSA
Other - Middle Name:NIDIA
Other - Last Name:CANEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DA
Mailing Address - Street 1:1631 WETZEL AVE BLDG 815
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4095
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:
Practice Address - Street 1:1631 WETZEL AVE BLDG 815
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4095
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant