Provider Demographics
NPI:1205075132
Name:RIVERA, ANTONIO F (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:F
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:JOSE DE DIEGO ST. #53 ALTOS
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-739-1092
Mailing Address - Fax:787-739-3272
Practice Address - Street 1:JOSE DE DIEGO #53 ALTOS
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-1092
Practice Address - Fax:787-739-3272
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics