Healthcare Provider Details

I. General information

NPI: 1336280338
Provider Name (Legal Business Name): ANGEL RIVERA RAMOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 EL PASEO RD
LAS CRUCES NM
88001-6024
US

IV. Provider business mailing address

2775 N ROADRUNNER PKWY APT 706
LAS CRUCES NM
88011-8112
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-1721
  • Fax: 575-525-9099
Mailing address:
  • Phone: 917-667-7546
  • Fax: 575-525-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number046797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: