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General NPI Number Information
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NPI Number | 1992833750
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Entity Type | Individual
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Provider Name | AMANDA L.. RIVERA CIRCUNS DMD,MSD
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Gender | Female
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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 | 1452 AVE ASHFORD STE 2
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City | SAN JUAN
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State | PR
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Zip | 00907-1556
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Country | US
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Telephone | 787-724-3970
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Fax |
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Provider Business Mailing Address
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Address Line | 1452 AVE ASHFORD STE 2
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City | SAN JUAN
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State | PR
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Zip | 00907-1556
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Country | US
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Telephone |
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0583
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License Number State | PR
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