Provider Demographics
NPI:1851684534
Name:RIVERA, ZELIDETH (DMD)
Entity Type:Individual
Prefix:
First Name:ZELIDETH
Middle Name:
Last Name: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 1:609 AVE TITO CASTRO
Mailing Address - Street 2:SUITE 102 PMB 388
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-841-4911
Mailing Address - Fax:
Practice Address - Street 1:609 CALLE FERROCARRIL
Practice Address - Street 2:EXT SANTA MARIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1110
Practice Address - Country:US
Practice Address - Phone:787-841-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29061223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice