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General NPI Number Information
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NPI Number | 1801924931
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Entity Type | Individual
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Provider Name | JESSE RIVAS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 811 N MACARTHUR BLVD
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City | IRVING
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State | TX
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Zip | 75061-7325
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Country | US
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Telephone | 972-254-4204
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Fax | 972-254-1183
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Provider Business Mailing Address
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Address Line | 811 N MACARTHUR BLVD
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City | IRVING
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State | TX
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Zip | 75061-7325
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Country | US
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Telephone | 972-254-4204
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Fax | 972-254-1183
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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 | 19348
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License Number State | TX
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