=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831645407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEFA A RIVAS DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2016
-----------------------------------------------------
Last Update Date | 09/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4527 47 STREET
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-482-8065
-----------------------------------------------------
Fax | 718-482-8066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4527 47TH ST
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-5225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-482-8065
-----------------------------------------------------
Fax | 718-482-8066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSEFA RIVAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-482-8065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------