Provider Demographics
NPI:1831152784
Name:RIVERA, DALVA I (DMD)
Entity type:Individual
Prefix:DR
First Name:DALVA
Middle Name:I
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 1:60 LUIS GANDIA SANTOS
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-262-0196
Mailing Address - Fax:787-262-0196
Practice Address - Street 1:109 AVE DR SUSONI
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1845
Practice Address - Country:US
Practice Address - Phone:787-262-0196
Practice Address - Fax:787-262-0196
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice