Healthcare Provider Details

I. General information

NPI: 1700090693
Provider Name (Legal Business Name): RICHARD D RIVA DDS & GERARD A BEGLEY DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HOWARD BLVD STE 201
MOUNT ARLINGTON NJ
07856-1532
US

IV. Provider business mailing address

22 HOWARD BLVD STE 201
MOUNT ARLINGTON NJ
07856-1532
US

V. Phone/Fax

Practice location:
  • Phone: 973-601-0606
  • Fax:
Mailing address:
  • Phone: 973-601-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI0102990
License Number StateNJ

VIII. Authorized Official

Name: DR. RICHARD RIVA
Title or Position: DENTIST ORALANDMAXILLOFACIAL SURGEY
Credential:
Phone: 973-601-0606