Provider Demographics
NPI:1952490518
Name:RIVARDO, RICK ALLEN (DMD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:ALLEN
Last Name:RIVARDO
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 1:8 WEST WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626
Mailing Address - Country:US
Mailing Address - Phone:724-327-1135
Mailing Address - Fax:
Practice Address - Street 1:1790 GOLDEN MILE HWY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2012
Practice Address - Country:US
Practice Address - Phone:724-327-2272
Practice Address - Fax:724-327-1078
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031053L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice