Provider Demographics
NPI:1669402186
Name:RIVERA, MARIO E (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:E
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 CAMINO ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4181
Mailing Address - Country:US
Mailing Address - Phone:787-858-4146
Mailing Address - Fax:
Practice Address - Street 1:HC 72 BOX 3512
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-9716
Practice Address - Country:US
Practice Address - Phone:787-869-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist