Provider Demographics
NPI:1386806578
Name:GARCIA RIVERA, HIRAM AMADO (DMD)
Entity type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:AMADO
Last Name:GARCIA RIVERA
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:19472 U.S ROUTE 11
Mailing Address - Street 2:SUITE 201W
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4037
Mailing Address - Country:US
Mailing Address - Phone:315-755-6725
Mailing Address - Fax:315-755-6726
Practice Address - Street 1:19472 US RTE 11
Practice Address - Street 2:STE 201W
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-755-6725
Practice Address - Fax:315-755-6756
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2024-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0537161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery