Provider Demographics
NPI:1922063833
Name:RIVERA, MERCEDES I (DMD)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:I
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AVE SAN AGUSTIN
Mailing Address - Street 2:URB. SAN AGUSTIN
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-0000
Mailing Address - Country:US
Mailing Address - Phone:787-384-2316
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1427
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-1427
Practice Address - Country:US
Practice Address - Phone:787-871-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice