Provider Demographics
NPI:1366787004
Name:CARLOS RIVAS D.D.S.,INC.
Entity type:Organization
Organization Name:CARLOS RIVAS D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-601-0350
Mailing Address - Street 1:24430 ALESSANDRO BLVD
Mailing Address - Street 2:104
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-2435
Mailing Address - Country:US
Mailing Address - Phone:951-601-0350
Mailing Address - Fax:951-601-0325
Practice Address - Street 1:24430 ALESSANDRO BLVD
Practice Address - Street 2:104
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-2435
Practice Address - Country:US
Practice Address - Phone:951-601-0350
Practice Address - Fax:951-601-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty