Provider Demographics
NPI:1396738571
Name:RIVERA-VIRELLA, BONIFACIO (DMD)
Entity type:Individual
Prefix:DR
First Name:BONIFACIO
Middle Name:
Last Name:RIVERA-VIRELLA
Suffix:
Gender:M
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:CIRUGIA ORAL Y MAXILOFACIAL RCM
Mailing Address - Street 2:PO BOX 29134
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-751-0858
Practice Address - Street 1:CLINICAS EXTERNAS ASEM - CIRUGIA ORAL Y MAXILOFACIAL
Practice Address - Street 2:CENTRO MEDICO DE PR, BO. MONACILLOS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-751-0858
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery