Provider Demographics
NPI:1578559423
Name:RIVERA, JUAN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:RIVERA
Suffix:
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:EDIF LA PALMA
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4861
Mailing Address - Country:US
Mailing Address - Phone:787-834-1525
Mailing Address - Fax:787-831-6005
Practice Address - Street 1:EDIF LA PALMA
Practice Address - Street 2:SUITE 3A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4861
Practice Address - Country:US
Practice Address - Phone:787-834-1525
Practice Address - Fax:787-986-7011
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry