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General NPI Number Information
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NPI Number | 1750609566
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Entity Type | Organization
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Legal Business Name | ARIVERA PLLC
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 2428 W ILLINOIS AVE
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City | DALLAS
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State | TX
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Zip | 75233-1106
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Country | US
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Telephone | 214-330-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 HUGO ST APT 5
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City | DALLAS
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State | TX
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Zip | 75204-2842
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Country | US
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Telephone | 214-476-8663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTONIO R RIVERA
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Credential | D.D.S.
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Telephone | 214-476-8663
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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 | 23308
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License Number State | TX
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