Provider Demographics
NPI:1700055613
Name:RAFAEL RIVERA, JR., DDS, PLLC
Entity Type:Organization
Organization Name:RAFAEL RIVERA, JR., DDS, PLLC
Other - Org Name:SMILESTARTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OFFICE MANAGERS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIROMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-747-1523
Mailing Address - Street 1:PO BOX 26394
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-6394
Mailing Address - Country:US
Mailing Address - Phone:704-816-1401
Mailing Address - Fax:704-398-7373
Practice Address - Street 1:3212 S WILMINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3538
Practice Address - Country:US
Practice Address - Phone:919-773-3002
Practice Address - Fax:919-773-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty