Provider Demographics
NPI:1962506329
Name:RIVARD, JEFFREY EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EARL
Last Name:RIVARD
Suffix:
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:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:CENTER CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55012-0235
Mailing Address - Country:US
Mailing Address - Phone:651-257-1140
Mailing Address - Fax:
Practice Address - Street 1:420 GRAND AVE.
Practice Address - Street 2:
Practice Address - City:CENTER CITY
Practice Address - State:MN
Practice Address - Zip Code:55012-0235
Practice Address - Country:US
Practice Address - Phone:651-257-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist