Healthcare Provider Details

I. General information

NPI: 1124368139
Provider Name (Legal Business Name): XIOMARA YOLANDA RIVERA HERNANDEZ D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 700
ALEXANDRIA VA
22304-1300
US

IV. Provider business mailing address

4660 KENMORE AVE STE 700
ALEXANDRIA VA
22304-1300
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-1327
  • Fax:
Mailing address:
  • Phone: 703-370-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401415817
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: