Healthcare Provider Details

I. General information

NPI: 1922063833
Provider Name (Legal Business Name): MERCEDES I RIVERA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1427
CIALES PR
00638-1427
US

IV. Provider business mailing address

1 AVE SAN AGUSTIN URB. SAN AGUSTIN
VEGA BAJA PR
00693-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-0601
  • Fax:
Mailing address:
  • Phone: 787-384-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1715
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: