Provider Demographics
NPI:1962247270
Name:RIVERA, SAMANTHA ANNE LOPERA (DMD)
Entity type:Individual
Prefix:
First Name:SAMANTHA ANNE
Middle Name:LOPERA
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 1:1308 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2719
Mailing Address - Country:US
Mailing Address - Phone:727-656-2320
Mailing Address - Fax:
Practice Address - Street 1:35648 US HWY 27 N
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3731
Practice Address - Country:US
Practice Address - Phone:863-353-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist