Provider Demographics
NPI:1841583176
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:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:KINGS
Authorized Official - Last Name:SHAFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-747-1524
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:336-747-1524
Mailing Address - Fax:336-306-8892
Practice Address - Street 1:655 LENOIR RHYNE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4133
Practice Address - Country:US
Practice Address - Phone:828-469-3000
Practice Address - Fax:828-469-2392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAFAEL RIVERA, JR, DDS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-19
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty