Provider Demographics
NPI:1568579290
Name:RIVERA, VICTOR JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZA LAS VEGAS MALL KM 391
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-855-5342
Mailing Address - Fax:787-779-7766
Practice Address - Street 1:AVE. SANTA JUANITA
Practice Address - Street 2:AK 5
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-780-7766
Practice Address - Fax:787-779-7766
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice