Basic Information
| Provider Information | |||||||||
| NPI: | 1114153632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 PEOPLES PL | ||||||||
| Address2: | |||||||||
| City: | HAVERHILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018323654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163977860 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 287 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | ALLSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021341010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177830500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 11/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN1855127 | MA | Y | Dental Providers | Dentist |
No ID Information.