Provider Demographics
NPI:1801870217
Name:RIVERA, MARIBEL (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
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:AVE BETANCES 181A
Mailing Address - Street 2:HERMANAS DAVILA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5183
Mailing Address - Country:US
Mailing Address - Phone:787-785-8737
Mailing Address - Fax:787-785-3859
Practice Address - Street 1:AVE BETANCES 181A
Practice Address - Street 2:HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5183
Practice Address - Country:US
Practice Address - Phone:787-785-8737
Practice Address - Fax:787-785-3859
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice