Provider Demographics
NPI:1700999208
Name:MALCOLM SUMBERA & DAVID RIVERA, DDS LLP
Entity Type:Organization
Organization Name:MALCOLM SUMBERA & DAVID RIVERA, DDS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMBERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-576-6118
Mailing Address - Street 1:1401 VICTORIA STATION DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3092
Mailing Address - Country:US
Mailing Address - Phone:361-576-6118
Mailing Address - Fax:
Practice Address - Street 1:1401 VICTORIA STATION DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3092
Practice Address - Country:US
Practice Address - Phone:361-576-6118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty