Provider Demographics
NPI:1679627632
Name:RIMA, IVELISSE M (DDS)
Entity type:Individual
Prefix:MRS
First Name:IVELISSE
Middle Name:M
Last Name:RIMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 87TH STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7534
Mailing Address - Country:US
Mailing Address - Phone:718-476-9244
Mailing Address - Fax:718-651-3814
Practice Address - Street 1:3715 87TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-476-9244
Practice Address - Fax:718-651-3814
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist