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General NPI Number Information
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NPI Number | 1184852691
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Entity Type | Individual
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Provider Name | ANDREW ALIDO RIVAMONTE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 1260 TRANCAS ST
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City | NAPA
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State | CA
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Zip | 94558-2910
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Country | US
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Telephone | 707-501-5102
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20305
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City | EL SOBRANTE
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State | CA
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Zip | 94820-0305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901020053
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 59690
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License Number State | CA
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