Provider Demographics
NPI:1235221102
Name:RIVERA, DAVID ORLANDO SR (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ORLANDO
Last Name:RIVERA
Suffix:SR
Gender:M
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:PMB 241 STE. 104
Mailing Address - Street 2:295 PALMAS INN WAY
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6030
Mailing Address - Country:US
Mailing Address - Phone:787-850-8081
Mailing Address - Fax:
Practice Address - Street 1:CARR 3 KM 85.6
Practice Address - Street 2:EDIFICIO PLAZA DEL SOL LOCAL 5
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4714
Practice Address - Country:US
Practice Address - Phone:787-850-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist