Provider Demographics
NPI:1538327333
Name:RIVERA, GABRIEL ALFONSO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ALFONSO
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:#304
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-999-6031
Mailing Address - Fax:818-999-6038
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:#304
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-999-6031
Practice Address - Fax:818-999-6038
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA24595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist