Individual
DR. RAFAEL RIVERA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4901 N TRYON ST, CHARLOTTE, NC 28213-7033
(704) 921-0204
Mailing address
1538 UNION RD, SUITE A, GASTONIA, NC 28054-2205
(704) 816-1402
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
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
03/12/2013
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