MEDICARE: RICARDO NICOLAS HERNANDEZ RIVERA DDS

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	122300000X	Dentist	DN20264	FL

General Provider Information

NPI Number	:	1730516931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO NICOLAS HERNANDEZ RIVERA DDS

Provider Business Mailing Address
First Line	:	1745 E HALLANDALE BCH BLVD. APT 2204
Second Line	:
City	:	HALLANDALE
State	:	FL
Zip	:	33009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6517 TAFT ST STE 201
Second Line	:	PRIMARY DENTAL CARE
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4063
Country	:	US
Telephone Number	:	954-399-7839
Fax Number	:	954-212-5718

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

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	01/06/2017

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