Provider Demographics
NPI:1689042004
Name:RIVERA, NATHALIE BLANC (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:BLANC
Last Name:RIVERA
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 1:49 CIDER MILL CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7387
Mailing Address - Country:US
Mailing Address - Phone:732-996-6995
Mailing Address - Fax:
Practice Address - Street 1:49 CIDER MILL CT
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7387
Practice Address - Country:US
Practice Address - Phone:329-966-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist