Provider Demographics
NPI:1871046797
Name:RIVERA, RICARDO ANDRES (DDS)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ANDRES
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 SAVIERS RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-5312
Mailing Address - Country:US
Mailing Address - Phone:818-742-5399
Mailing Address - Fax:
Practice Address - Street 1:3005 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-5312
Practice Address - Country:US
Practice Address - Phone:818-742-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist