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NPI Code Detail

MEDICARE: DR. RAFAEL RIVERA JR. D.D.S.

MEDICARE: DR. RAFAEL RIVERA JR. D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6870NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1902HTOTHERNCBLUE CROSS BLUE SHIELD NC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013912427
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAFAEL RIVERA JR. D.D.S.
Provider Business Mailing Address
First Line : 1538 UNION RD
Second Line : SUITE A
City : GASTONIA
State : NC
Zip : 28054-2205
Country : US
Telephone Number : 704-816-1402
Fax Number :
Provider Business Practice Location Address
First Line : 4901 N TRYON ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28213-7033
Country : US
Telephone Number : 704-921-0204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 03/12/2013

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