Provider Demographics
NPI:1922538255
Name:RIVERA, MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:RIVERA
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 1:814 SLOOP AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-2992
Mailing Address - Country:US
Mailing Address - Phone:704-933-2116
Mailing Address - Fax:704-932-2195
Practice Address - Street 1:814 SLOOP AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-2992
Practice Address - Country:US
Practice Address - Phone:704-933-2116
Practice Address - Fax:704-932-2195
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8929122300000X
NC8929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist