Provider Demographics
NPI:1932287141
Name:RIVERA, JOSE PIO SR (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:PIO
Last Name:RIVERA
Suffix:SR
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 1:45 ARENAS STREET
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-850-8081
Mailing Address - Fax:787-285-1060
Practice Address - Street 1:PLAZA DEL SOL BUILDING - OFFICE #3
Practice Address - Street 2:KM 85-6 STAR RD #3
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-8081
Practice Address - Fax:787-285-1060
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist