Provider Demographics
NPI:1790201838
Name:RIVERA RIVERA, LLELENYS PAOLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LLELENYS
Middle Name:PAOLA
Last Name:RIVERA RIVERA
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 1:510 RICHMOND AVE APT 223
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5577
Mailing Address - Country:US
Mailing Address - Phone:787-340-8691
Mailing Address - Fax:
Practice Address - Street 1:941 E HIGHWAY 90A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-4024
Practice Address - Country:US
Practice Address - Phone:281-342-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX358341223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics