Provider Demographics
NPI:1912361130
Name:RIVERA, ALEXANDRIA ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:ANNE
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 1:202 VAN RIPPER AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1923
Mailing Address - Country:US
Mailing Address - Phone:914-513-1947
Mailing Address - Fax:914-423-4642
Practice Address - Street 1:579 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-890-9300
Practice Address - Fax:203-890-9250
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR475201961599021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice