Provider Demographics
NPI:1922037522
Name:RIVERA-CASTRO, ANGEL M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
Last Name:RIVERA-CASTRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11954 NARCOOSSEE RD STE 102-129
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6998
Mailing Address - Country:US
Mailing Address - Phone:407-360-2465
Mailing Address - Fax:
Practice Address - Street 1:8185 LEE VISTA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8304
Practice Address - Country:US
Practice Address - Phone:407-881-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18238122300000X
PR25341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist