Provider Demographics
NPI:1790998961
Name:RIVERA-COLON, DIEGO (DMD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:RIVERA-COLON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CALLE YABOA REAL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3351
Mailing Address - Country:US
Mailing Address - Phone:787-762-0120
Mailing Address - Fax:787-762-0265
Practice Address - Street 1:925 CALLE YABOA REAL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3351
Practice Address - Country:US
Practice Address - Phone:787-762-0120
Practice Address - Fax:787-762-0265
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice