Provider Demographics
NPI:1740687201
Name:LARIVEY, DANIELLE (DDS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LARIVEY
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:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:972-552-5128
Mailing Address - Fax:
Practice Address - Street 1:501 FM 548
Practice Address - Street 2:SUITE 100
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6284
Practice Address - Country:US
Practice Address - Phone:972-552-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-29
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist