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General NPI Number Information
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NPI Number | 1215344106
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Entity Type | Individual
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Provider Name | CANDIDO RIVERA DDS
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Gender | Male
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Dates
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Enumeration Date | 07/13/2014
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Last Update Date | 07/13/2014
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Provider Practice Location Address
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Address Line | 2936 N NEENAH AVE
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City | CHICAGO
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State | IL
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Zip | 60634-4960
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Country | US
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Telephone | 773-369-6381
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Fax |
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Provider Business Mailing Address
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Address Line | 7117 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-1450
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Country | US
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Telephone | 262-942-7000
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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 | 1000959-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019029937
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License Number State | IL
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