Healthcare Provider Details

I. General information

NPI: 1952307936
Provider Name (Legal Business Name): RAMON D. RIVERA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 AVE GEN VALERO
FAJARDO PR
00738-4844
US

IV. Provider business mailing address

PO BOX 24
PUERTO REAL PR
00740-0024
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-3465
  • Fax:
Mailing address:
  • Phone: 787-860-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1439
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: