Provider Demographics
NPI:1265593081
Name:RIVIELLO, DONALD JAMES (DM,D)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JAMES
Last Name:RIVIELLO
Suffix:
Gender:M
Credentials:DM,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 KINGS HWY E
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2009
Mailing Address - Country:US
Mailing Address - Phone:856-429-1930
Mailing Address - Fax:
Practice Address - Street 1:35 KINGS HWY E
Practice Address - Street 2:SUITE 109
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2009
Practice Address - Country:US
Practice Address - Phone:856-429-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011365001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice