Provider Demographics
NPI:1780179119
Name:RIVERO FERNANDEZ, SONIA (DMD)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:RIVERO FERNANDEZ
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 1:39931 PARKINSONIA ST
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3458
Mailing Address - Country:US
Mailing Address - Phone:813-405-7935
Mailing Address - Fax:
Practice Address - Street 1:870 N US HIGHWAY 27 STE A
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3108
Practice Address - Country:US
Practice Address - Phone:352-282-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist