Provider Demographics
NPI:1124059472
Name:RIVERA, JAIME (DMD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:RIVERA
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7482 PASEO DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3200
Mailing Address - Country:US
Mailing Address - Phone:915-585-7550
Mailing Address - Fax:915-585-7552
Practice Address - Street 1:7482 PASEO DEL NORTE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3200
Practice Address - Country:US
Practice Address - Phone:915-585-7550
Practice Address - Fax:915-585-7552
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220091223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213495902Medicaid
TX00142477OtherDPS
NMDD3905OtherNEW MEXICO DENTAL LICENSE
TX22009OtherTEXAS LICENSE DENTIST
TX213495901Medicaid
NMDD3905OtherNEW MEXICO DENTAL LICENSE