Provider Demographics
NPI:1316100712
Name:RIVAS, ALEJANDRA CRISTINA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRA
Middle Name:CRISTINA
Last Name:RIVAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 SAMUELS AVE APT 8307
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-2518
Mailing Address - Country:US
Mailing Address - Phone:469-939-8313
Mailing Address - Fax:
Practice Address - Street 1:1405 CANNON PKWY
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3620
Practice Address - Country:US
Practice Address - Phone:817-430-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice