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NPI Code Detail

MEDICARE: RAFAEL RIVERA, JR, DDS, PLLC

MEDICARE: RAFAEL RIVERA, JR, DDS, PLLC
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
1122300000XDentist

General Provider Information

NPI Number : 1194994004
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAFAEL RIVERA, JR, DDS, PLLC
Provider Business Mailing Address
First Line : PO BOX 26394
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27114-6394
Country : US
Telephone Number : 704-816-1401
Fax Number : 704-398-7373
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 : 704-921-4095
Authorized Official
Title or Position : DIRECTOR OF OFFICE MANAGERS
Name : MRS. MAUREEN SHIROMA
Credential :
Telephone Number : 336-747-1523
Provider Enumeration Date : 02/25/2008
Last Update Date : 04/12/2024

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