Provider Demographics
NPI:1831306513
Name:RIVERO, MARILYN
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:RIVERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:KOUTRAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:235 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7592
Mailing Address - Country:US
Mailing Address - Phone:508-872-4848
Mailing Address - Fax:508-872-4849
Practice Address - Street 1:235 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7592
Practice Address - Country:US
Practice Address - Phone:508-872-4848
Practice Address - Fax:508-872-4849
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice