Provider Demographics
NPI:1942325352
Name:RIVERA, ANGEL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:J
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 1:44 CALLE JUAN C BORBON
Mailing Address - Street 2:BOX 630
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5378
Mailing Address - Country:US
Mailing Address - Phone:787-287-4656
Mailing Address - Fax:787-287-1044
Practice Address - Street 1:44 CALLE JUAN C BORBON
Practice Address - Street 2:BOX 630
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5378
Practice Address - Country:US
Practice Address - Phone:787-287-4656
Practice Address - Fax:787-287-1044
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4-0471RIOtherSSS INSURANCE PROVIDER ID