Provider Demographics
NPI:1598730442
Name:RIVERA, JIM EDUARDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:EDUARDO
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 1:32 CALLE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3511
Mailing Address - Country:US
Mailing Address - Phone:787-851-1897
Mailing Address - Fax:787-851-1897
Practice Address - Street 1:32 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3511
Practice Address - Country:US
Practice Address - Phone:787-851-1897
Practice Address - Fax:787-851-1897
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice