Provider Demographics
NPI:1871763961
Name:MIRANDA-RIVERA, YARITZA (DMD)
Entity type:Individual
Prefix:
First Name:YARITZA
Middle Name:
Last Name:MIRANDA-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 1:4453 CHESTNUT RIDGE RD
Mailing Address - Street 2:APT. #1
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3246
Mailing Address - Country:US
Mailing Address - Phone:716-228-0181
Mailing Address - Fax:
Practice Address - Street 1:1100 LONG POND RD
Practice Address - Street 2:SUITE 115
Practice Address - City:GREECE
Practice Address - State:NY
Practice Address - Zip Code:14626-1177
Practice Address - Country:US
Practice Address - Phone:585-225-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051791-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics