Provider Demographics
NPI:1740459650
Name:RAFAEL RIVERA, JR., DDS, PLLC
Entity type:Organization
Organization Name:RAFAEL RIVERA, JR., DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OFFICE MANAGERS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIROMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-747-1523
Mailing Address - Street 1:2211 EXECUTIVE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3661
Mailing Address - Country:US
Mailing Address - Phone:704-395-6000
Mailing Address - Fax:704-395-6000
Practice Address - Street 1:2041 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5147
Practice Address - Country:US
Practice Address - Phone:336-777-1272
Practice Address - Fax:336-777-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty