MEDICARE: EUNICE RIVERA

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
1	1223G0001X	General Practice Dentistry	28093	TX

General Provider Information

NPI Number	:	1104176742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE RIVERA

Provider Business Mailing Address
First Line	:	5801 SPRING VALLEY RD
Second Line	:	APT 410
City	:	DALLAS
State	:	TX
Zip	:	75254-3376
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 SPRING VALLEY RD
Second Line	:	APT 410
City	:	DALLAS
State	:	TX
Zip	:	75254-3376
Country	:	US
Telephone Number	:	787-457-3236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/11/2012

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Directions to “ EUNICE RIVERA ” Practice Location

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