Healthcare Provider Details

I. General information

NPI: 1457310633
Provider Name (Legal Business Name): OMAR RIVERA D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: OMAR RIVERA D.M.D

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO QUEBRADILLAS CARR 152 KM 7.6
BARRANQUITAS PR
00794
US

IV. Provider business mailing address

HC-71 BOX 3278
NARANJITO PUERTO RICO
00719
UY

V. Phone/Fax

Practice location:
  • Phone: 787-370-4346
  • Fax:
Mailing address:
  • Phone: 787-870-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2524
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: