Individual
JONATHON RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
701 STATE ROAD 60 E, LAKE WALES, FL 33853-4240
(863) 676-6021
Mailing address
701 STATE ROAD 60 E, LAKE WALES, FL 33853-4240
(863) 676-6021
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
28159
FL
Other
Enumeration date
06/16/2023
Last updated
06/16/2023
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