# JESSE RIVAS, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457625865
- **Authorized official:** DR. JESSE RIVAS D.D.S. (PRESIDENT/DENTIST)
- **Authorized official phone:** (972) 254-4204

## Contact information

- **Practice address:** 811 N MACARTHUR BLVD, IRVING, TX 75061-7325
- **Practice address phone:** (972) 254-4204
- **Practice address fax:** (972) 254-1183
- **Mailing address:** 811 N MACARTHUR BLVD, IRVING, TX 75061-7325
- **Mailing address phone:** (972) 254-4204
- **Mailing address fax:** (972) 254-1183

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 19348 | TX | Yes |

## Other

- **Enumeration date:** 03/02/2012
- **Last updated:** 03/02/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 007920405 | — | TX |