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NPI Code Detail

MEDICARE: DR. ANTONIO RAMON RIVERA D.D.S.

MEDICARE: DR. ANTONIO RAMON RIVERA D.D.S.
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
1122300000XDentist23308TX
21223G0001XGeneral Practice Dentistry23308TX

General Provider Information

NPI Number : 1912198482
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTONIO RAMON RIVERA D.D.S.
Provider Business Mailing Address
First Line : 2428 W ILLINOIS AVE
Second Line :
City : DALLAS
State : TX
Zip : 75233-1106
Country : US
Telephone Number : 214-330-0222
Fax Number : 214-330-0317
Provider Business Practice Location Address
First Line : 2428 W ILLINOIS AVE
Second Line :
City : DALLAS
State : TX
Zip : 75233-1106
Country : US
Telephone Number : 214-330-0222
Fax Number : 214-330-0317
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2007
Last Update Date : 06/16/2021

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