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Individual

RAFAEL RIVERA JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
4901 N TRYON ST, CHARLOTTE, NC 28213-7033
(704) 921-0204
Mailing address
3340 ROBINWOOD RD STE 100-406, GASTONIA, NC 28054-6689
(704) 816-1402

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6870
NC
1223G0001X
General Practice Dentistry
Primary
6870
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
89014NG
NC
01
902HT
BLUE CROSS BLUE SHIELD NC
NC
Enumeration date
06/14/2005
Last updated
06/02/2026
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