MEDICARE: DR. MARTA M RIVERA DMD

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	1223P0221X	Pediatric Dentistry	DN 14483	FL

General Provider Information

NPI Number	:	1972601920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTA M RIVERA DMD

Provider Business Mailing Address
First Line	:	5326 PRIMROSE LAKE CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3589
Country	:	US
Telephone Number	:	813-374-0388
Fax Number	:	813-374-0390

Provider Business Practice Location Address
First Line	:	5326 PRIMROSE LAKE CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3589
Country	:	US
Telephone Number	:	813-374-0388
Fax Number	:	813-374-0388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/26/2010

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