Provider Demographics
NPI:1245987080
Name:RIVERO DMD, INC
Entity type:Organization
Organization Name:RIVERO DMD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-923-7433
Mailing Address - Street 1:5023 AUGUST ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1204
Mailing Address - Country:US
Mailing Address - Phone:407-923-7433
Mailing Address - Fax:
Practice Address - Street 1:3560 FAIRMOUNT AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-3420
Practice Address - Country:US
Practice Address - Phone:619-877-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty