Provider Demographics
NPI:1184291189
Name:RIVERA, YULL HAE (RDH)
Entity type:Individual
Prefix:
First Name:YULL HAE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 S GIBRALTAR ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3767
Mailing Address - Country:US
Mailing Address - Phone:303-588-7535
Mailing Address - Fax:
Practice Address - Street 1:5456 S GIBRALTAR ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3767
Practice Address - Country:US
Practice Address - Phone:303-588-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002024870124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist