Provider Demographics
NPI:1629543376
Name:DAVID RIVERS DDS, PLLC
Entity Type:Organization
Organization Name:DAVID RIVERS DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-336-5015
Mailing Address - Street 1:203 GEORGE HOPPER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-6526
Mailing Address - Country:US
Mailing Address - Phone:469-336-5015
Mailing Address - Fax:
Practice Address - Street 1:203 GEORGE HOPPER RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6526
Practice Address - Country:US
Practice Address - Phone:469-336-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherDENTIST