=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376664763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD D RIVA DDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 01/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 MAIN ST SUITE 201
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-635-5800
-----------------------------------------------------
Fax | 973-635-5383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 MAIN ST SUITE 201
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-635-5800
-----------------------------------------------------
Fax | 973-635-5383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORAL AND MAXILLOFACIAL SURGEONS
-----------------------------------------------------
Name | DR. RICHARD D RIVA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 973-635-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 22DI01029900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------