Provider Demographics
NPI:1801981568
Name:RIVES, WILLIAM OSCAR II (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:OSCAR
Last Name:RIVES
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 HIGHWAY 51 STE D
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7648
Mailing Address - Country:US
Mailing Address - Phone:601-605-2525
Mailing Address - Fax:601-605-2524
Practice Address - Street 1:1029 HIGHWAY 51 STE D
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7648
Practice Address - Country:US
Practice Address - Phone:601-605-2525
Practice Address - Fax:601-605-2524
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06684372Medicaid