Provider Demographics
NPI:1255487377
Name:RIVERA, DAMARIS (DMD)
Entity type:Individual
Prefix:DR
First Name:DAMARIS
Middle Name:
Last Name:RIVERA
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:PO BOX 6722
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6722
Mailing Address - Country:US
Mailing Address - Phone:787-391-2194
Mailing Address - Fax:787-827-5852
Practice Address - Street 1:PASEO ADRIAN ACEVEDO (HOSPITAL)
Practice Address - Street 2:CARR. 119, KM.27.4
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670
Practice Address - Country:US
Practice Address - Phone:787-827-5852
Practice Address - Fax:787-827-5852
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0025601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice