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General NPI Number Information
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NPI Number | 1457484206
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Entity Type | Organization
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Legal Business Name | DIEGO E. RIVAS DDS PA CORPORATION
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 9820 HUEBNER RD SUITE 107
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City | SAN ANTONIO
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State | TX
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Zip | 78240-3265
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Country | US
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Telephone | 210-697-3500
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Fax | 210-697-3505
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Provider Business Mailing Address
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Address Line | 9820 HUEBNER RD SUITE 107
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City | SAN ANTONIO
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State | TX
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Zip | 78240-3265
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Country | US
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Telephone | 210-697-3500
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Fax | 210-697-3505
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIEGO E RIVAS
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Credential | DDS
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Telephone | 210-697-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23643
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License Number State | TX
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