Provider Demographics
NPI:1730594896
Name:JAIME RIVERA ORTHODONTICS, P.C.
Entity type:Organization
Organization Name:JAIME RIVERA ORTHODONTICS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-585-7550
Mailing Address - Street 1:6901 HELEN OF TROY STE D1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3130
Mailing Address - Country:US
Mailing Address - Phone:915-585-7550
Mailing Address - Fax:915-585-7552
Practice Address - Street 1:6901 HELEN OF TROY STE D1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3130
Practice Address - Country:US
Practice Address - Phone:915-585-7550
Practice Address - Fax:915-585-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22009OtherTX LICENSE
NMDD3905OtherNM LICENSE
TX213495901Medicaid
00142477OtherDPS
TX213495902Medicaid
BR9440227OtherDEA