Provider Demographics
NPI:1053381988
Name:RIVERA, LIZZA IVETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:LIZZA
Middle Name:IVETTE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W 16TH AVE
Mailing Address - Street 2:SUITE 52
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7100
Mailing Address - Country:US
Mailing Address - Phone:305-825-9899
Mailing Address - Fax:305-825-9858
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:SUITE 52
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7100
Practice Address - Country:US
Practice Address - Phone:305-825-9899
Practice Address - Fax:305-825-9858
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 217021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry