Organization
JESSUP DENTAL ASSOCIATES T/A BLANK RIVERA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMILIO ENRIQUE RIVERA DDS (PRESIDENT)
(410) 799-2692
Entity
Organization
Contact information
Practice address
8182 LARK BROWN RD, SUITE 101, ELKRIDGE, MD 21075-6420
(410) 799-2692
(410) 799-3931
Mailing address
8182 LARK BROWN RD, SUITE 101, ELKRIDGE, MD 21075-6420
(410) 799-2692
(410) 799-3931
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7902
MD
1223G0001X
General Practice Dentistry
8363
MD
Other
Enumeration date
05/18/2006
Last updated
08/22/2020
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