Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 1476 | PR |
N | 1223X0400X | Orthodontists | 37279 | CA |
NPI | 1033101258 |
---|---|
Provider Name | Dr. Augusto Dennis Rivera III |
First Address | Rockville, MD 20852-2981 |
Second Address | Bethesda, MD 20889-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/07/2007 |