MEDICARE: JAIME RIVERA ORTHODONTICS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22009	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22009	OTHER	TX	TX LICENSE
2	DD3905	OTHER	NM	NM LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	00142477	OTHER		DPS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730594896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAIME RIVERA ORTHODONTICS, P.C.

Provider Business Mailing Address
First Line	:	6901 HELEN OF TROY STE D1
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3130
Country	:	US
Telephone Number	:	915-585-7550
Fax Number	:	915-585-7552

Provider Business Practice Location Address
First Line	:	6901 HELEN OF TROY STE D1
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3130
Country	:	US
Telephone Number	:	915-585-7550
Fax Number	:	915-585-7552

Authorized Official
Title or Position	:	OWNER/ORTHODONTIST
Name	:	DR. JAIME RIVERA
Credential	:	DMD
Telephone Number	:	915-585-7550

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	03/07/2023

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Directions to “JAIME RIVERA ORTHODONTICS, P.C. ” Practice Location

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