Healthcare Provider Details

I. General information

NPI: 1992833750
Provider Name (Legal Business Name): AMANDA L.. RIVERA CIRCUNS DMD,MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 AVE ASHFORD STE 2
SAN JUAN PR
00907-1556
US

IV. Provider business mailing address

1452 AVE ASHFORD STE 2
SAN JUAN PR
00907-1556
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-3970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0583
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: