MEDICARE: DR. LOUIS RAUL RIVERA 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
1	1223G0001X	General Practice Dentistry	DD1537	NM

General Provider Information

NPI Number	:	1477528511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS RAUL RIVERA D.D.S

Provider Business Mailing Address
First Line	:	4824 MCMAHON BLVD NW
Second Line	:	SUITE 105
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5412
Country	:	US
Telephone Number	:	505-890-1911
Fax Number	:	505-890-5014

Provider Business Practice Location Address
First Line	:	4824 MCMAHON BLVD NW
Second Line	:	SUITE 105
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5412
Country	:	US
Telephone Number	:	505-890-1911
Fax Number	:	505-890-5014

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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