MEDICARE: JAVIER ANTONIO RIVERA QUINTERO D.M.D.

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	3361	PR
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1962058990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER ANTONIO RIVERA QUINTERO D.M.D.

Provider Business Mailing Address
First Line	:	323 CAMINO DEL GUAMA
Second Line	:	SABANERA DORADO
City	:	DORADO
State	:	PR
Zip	:	00646
Country	:	US
Telephone Number	:	787-626-6581
Fax Number	:	787-626-6581

Provider Business Practice Location Address
First Line	:	456 CALLE TNTE CESAR GONZALEZ
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2628
Country	:	US
Telephone Number	:	787-753-2376
Fax Number	:	787-767-8392

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

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	10/21/2021

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