Healthcare Provider Details

I. General information

NPI: 1033101258
Provider Name (Legal Business Name): AUGUSTO DENNIS RIVERA III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL POSTGRADUATE DENTAL SCHOOL 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

5804 EDSON LN
ROCKVILLE MD
20852-2981
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-5451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1476
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number37279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: