MEDICARE: CHRISTIAN RIVERA DMD

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	35275	TX

General Provider Information

NPI Number	:	1912568593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN RIVERA DMD

Provider Business Mailing Address
First Line	:	2805 SANTA ERICA ST
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-7185
Country	:	US
Telephone Number	:	956-379-7574
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 W EXPY 83 # 10
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78503-0029
Country	:	US
Telephone Number	:	956-625-0969
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	08/28/2019

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Directions to “ CHRISTIAN RIVERA DMD” Practice Location

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