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General NPI Number Information
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NPI Number | 1740411016
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Entity Type | Individual
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Provider Name | KRISTINA RIVERS DDS
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Gender | Female
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 110 E VILLA MARIA RD
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City | BRYAN
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State | TX
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Zip | 77801-3147
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Country | US
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Telephone | 979-779-6146
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Fax |
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Provider Business Mailing Address
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Address Line | 110 E VILLA MARIA RD STE A
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City | BRYAN
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State | TX
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Zip | 77801-3147
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Country | US
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Telephone | 979-779-6146
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Fax | 979-779-6250
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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 | 23933
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License Number State | TX
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