Provider Demographics
NPI:1609165182
Name:RIVERA-NEGRON, CARMEN MYRIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MYRIAM
Last Name:RIVERA-NEGRON
Suffix:
Gender:F
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:F4 CALLE TREVI
Mailing Address - Street 2:PASEO LA FUENTE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6472
Mailing Address - Country:US
Mailing Address - Phone:787-599-2002
Mailing Address - Fax:787-287-3190
Practice Address - Street 1:6 AVE ESMERALDA
Practice Address - Street 2:URB PONCE DE LEON
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4427
Practice Address - Country:US
Practice Address - Phone:787-599-2002
Practice Address - Fax:787-287-3190
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist