MEDICARE: ARIVERA 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
1	122300000X	Dentist	23308	TX

General Provider Information

NPI Number	:	1750609566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIVERA PLLC

Provider Business Mailing Address
First Line	:	2420 HUGO ST APT 5
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2842
Country	:	US
Telephone Number	:	214-476-8663
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-1106
Country	:	US
Telephone Number	:	214-330-0222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTONIO R RIVERA
Credential	:	D.D.S.
Telephone Number	:	214-476-8663

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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