Provider Demographics
NPI:1154808228
Name:RIVERA MENDEZ, VICTOR ANTONIO (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANTONIO
Last Name:RIVERA MENDEZ
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:600 AVE JESUS T PINERO APT 1104
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4173
Mailing Address - Country:US
Mailing Address - Phone:787-613-0433
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE SANTA CRUZ SUITE 103
Practice Address - Street 2:SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-925-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics