Provider Demographics
NPI:1184159873
Name:STEVEN GAGLIO RIVAS DDS PLLC
Entity type:Organization
Organization Name:STEVEN GAGLIO RIVAS DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GAGLIO
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-815-6329
Mailing Address - Street 1:222 E RICE ST
Mailing Address - Street 2:
Mailing Address - City:FALFURRIAS
Mailing Address - State:TX
Mailing Address - Zip Code:78355-3622
Mailing Address - Country:US
Mailing Address - Phone:707-815-6330
Mailing Address - Fax:
Practice Address - Street 1:222 E RICE ST
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-3622
Practice Address - Country:US
Practice Address - Phone:707-815-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty