Provider Demographics
NPI:1740472257
Name:RIVERA, IRMA ESTHER (DMD)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:ESTHER
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7828 DAY CREEK BLVD
Mailing Address - Street 2:APT. #833
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8569
Mailing Address - Country:US
Mailing Address - Phone:310-597-9445
Mailing Address - Fax:
Practice Address - Street 1:7828 DAY CREEK BLVD
Practice Address - Street 2:APT. #833
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8569
Practice Address - Country:US
Practice Address - Phone:310-597-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist