Provider Demographics
NPI:1427177096
Name:RIVERA-COLON, LOURDES EMILIA (DMD)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:EMILIA
Last Name:RIVERA-COLON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7104
Mailing Address - Country:US
Mailing Address - Phone:727-341-0825
Mailing Address - Fax:
Practice Address - Street 1:5718 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7104
Practice Address - Country:US
Practice Address - Phone:727-341-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 138281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice