Provider Demographics
NPI:1962058990
Name:RIVERA QUINTERO, JAVIER ANTONIO (DMD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:ANTONIO
Last Name:RIVERA QUINTERO
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 1:323 CAMINO DEL GUAMA
Mailing Address - Street 2:SABANERA DORADO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-626-6581
Mailing Address - Fax:787-626-6581
Practice Address - Street 1:456 CALLE TNTE CESAR GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2628
Practice Address - Country:US
Practice Address - Phone:787-753-2376
Practice Address - Fax:787-767-8392
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33611223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program