Provider Demographics
NPI:1184061004
Name:RIVERA, KIMBERLY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19831 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2851
Mailing Address - Country:US
Mailing Address - Phone:714-693-0990
Mailing Address - Fax:714-693-0766
Practice Address - Street 1:19831 YORBA LINDA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2851
Practice Address - Country:US
Practice Address - Phone:714-693-0990
Practice Address - Fax:714-693-0766
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist