Provider Demographics
NPI:1730516931
Name:HERNANDEZ RIVERA, RICARDO NICOLAS (DDS)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:NICOLAS
Last Name:HERNANDEZ RIVERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 E HALLANDALE BCH BLVD. APT 2204
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6517 TAFT ST STE 201
Practice Address - Street 2:PRIMARY DENTAL CARE
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4063
Practice Address - Country:US
Practice Address - Phone:954-399-7839
Practice Address - Fax:954-212-5718
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist