Provider Demographics
NPI:1780655365
Name:RIJOS, CARMEN MIREYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MIREYA
Last Name:RIJOS
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 1:2420 DAVIDSON AVE
Mailing Address - Street 2:1FL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6318
Mailing Address - Country:US
Mailing Address - Phone:718-563-0303
Mailing Address - Fax:718-367-7117
Practice Address - Street 1:2420 DAVIDSON AVE
Practice Address - Street 2:1FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6318
Practice Address - Country:US
Practice Address - Phone:718-563-0303
Practice Address - Fax:718-367-7117
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0456701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4860OtherDENTAL
NY01526392Medicaid