Provider Demographics
NPI:1316091309
Name:RIVERA, JOANNE P (DDS)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:P
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W. AMERICAN CANYON RD.
Mailing Address - Street 2:SUITE M-8
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503
Mailing Address - Country:US
Mailing Address - Phone:707-557-9080
Mailing Address - Fax:
Practice Address - Street 1:120 W. AMERICAN CANYON RD.
Practice Address - Street 2:SUITE M-8
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503
Practice Address - Country:US
Practice Address - Phone:707-557-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice