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General NPI Number Information
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NPI Number | 1659939098
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Entity Type | Individual
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Provider Name | VALERIE ANNE LARIVIERE DMD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 813B MAIN ST
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City | WATERBORO
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State | ME
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Zip | 04087-3006
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Country | US
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Telephone | 207-247-3511
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Fax |
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Provider Business Mailing Address
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Address Line | 25 DEAN DR
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City | NORTH WATERBORO
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State | ME
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Zip | 04061-4300
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN4703
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License Number State | ME
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