Provider Demographics
NPI:1740620269
Name:GRUPO DENTAL DR RIVERA ADAMES
Entity type:Organization
Organization Name:GRUPO DENTAL DR RIVERA ADAMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISTA
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:ELIER
Authorized Official - Last Name:RIVERA ADAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-734-0000
Mailing Address - Street 1:PO BOX 1791
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1791
Mailing Address - Country:US
Mailing Address - Phone:787-734-0000
Mailing Address - Fax:787-734-1647
Practice Address - Street 1:URB MADRID CALLE LOPEZ HORMAZABAL C 42
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-734-0000
Practice Address - Fax:787-734-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty