Provider Demographics
NPI:1538292958
Name:RIVA, RICHARD D (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:RIVA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2433
Mailing Address - Country:US
Mailing Address - Phone:973-635-5800
Mailing Address - Fax:
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:07928-2433
Practice Address - Country:US
Practice Address - Phone:973-635-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI010299001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI01029900OtherLICENSE NUMBER
NJ22DI01029900OtherLICENSE NUMBER