Provider Demographics
NPI:1740305028
Name:RIVAS, POLLY DIANNE (DDS)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:DIANNE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 STOCKTON ST FL 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5320
Mailing Address - Country:US
Mailing Address - Phone:415-397-4827
Mailing Address - Fax:415-397-4820
Practice Address - Street 1:260 STOCKTON ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5320
Practice Address - Country:US
Practice Address - Phone:415-397-4827
Practice Address - Fax:415-397-4820
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist