Provider Demographics
NPI:1639581390
Name:RIVERA, REGINA R (DDS)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:R
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 STOCKDALE HWY
Mailing Address - Street 2:STE. 110
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3654
Mailing Address - Country:US
Mailing Address - Phone:661-665-0500
Mailing Address - Fax:661-665-0710
Practice Address - Street 1:9450 STOCKDALE HWY
Practice Address - Street 2:STE 110
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3654
Practice Address - Country:US
Practice Address - Phone:661-665-0500
Practice Address - Fax:661-665-0710
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist