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General NPI Number Information
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NPI Number | 1801166947
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Entity Type | Organization
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Legal Business Name | AREVIR DENTAL PSC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | ATRIUM OFFICE CENTER 530 DE LA CONCECION AVE SUITE 316
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City | SAN JUAN
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State | PR
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Zip | 00901
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Country | US
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Telephone | 787-209-7898
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Fax |
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Provider Business Mailing Address
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Address Line | COND PARQUE DE LOYOLA TORRE NORTE APT 1905
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-209-7898
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JAYSON XAVIER RIVERA
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Credential | D.M.D.
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Telephone | 787-209-7898
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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 | 2891
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License Number State | PR
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