MEDICARE: RIVERO DMD, INC

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

General Provider Information

NPI Number	:	1245987080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERO DMD, INC

Provider Business Mailing Address
First Line	:	5023 AUGUST ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1204
Country	:	US
Telephone Number	:	407-923-7433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3560 FAIRMOUNT AVE STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-3420
Country	:	US
Telephone Number	:	619-877-0124
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CARLOS ANTONIO RIVERO
Credential	:	DMD
Telephone Number	:	407-923-7433

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	04/01/2025

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