Healthcare Provider Details

I. General information

NPI: 1427316603
Provider Name (Legal Business Name): EDWARD RICARDO GUZMAN RIVERA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 AVE MUNOZ RIVERA
PONCE PR
00717-0639
US

IV. Provider business mailing address

1208 AVE MUNOZ RIVERA
PONCE PR
00717-0639
US

V. Phone/Fax

Practice location:
  • Phone: 787-362-4944
  • Fax:
Mailing address:
  • Phone: 787-362-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD3209
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: