Provider Demographics
NPI:1245622455
Name:RIVERS, ELIZABETH (DMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 SARA RD SE
Mailing Address - Street 2:STE C
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-720-5648
Mailing Address - Fax:
Practice Address - Street 1:1594 SARA RD SE
Practice Address - Street 2:STE C
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1862
Practice Address - Country:US
Practice Address - Phone:505-896-2200
Practice Address - Fax:505-896-2300
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist