Provider Demographics
NPI:1558783308
Name:RIVES, ROBERT WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAYNE
Last Name:RIVES
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 1:209 WOODLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9749
Mailing Address - Country:US
Mailing Address - Phone:601-664-2600
Mailing Address - Fax:601-664-2650
Practice Address - Street 1:209 WOODLINE DRIVE
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9749
Practice Address - Country:US
Practice Address - Phone:601-664-2600
Practice Address - Fax:601-664-2650
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1807-78122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist