Donnie Rivera, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019028351 Issued in IL

Practice address

3220 W Vliet St
Milwaukee, WI 53208-2453

Phone

(414) 231-4057

Fax

(414) 231-4013

NPI assigned

Jul 20, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 17, 2015 through Sep 17, 2027

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380153600000",
    "number": "1093028904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 W VLIET ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532082453",
            "telephone_number": "414-231-4057",
            "fax_number": "414-231-4013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 W VLIET ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532082453",
            "telephone_number": "414-231-4057",
            "fax_number": "414-231-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "DONNIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-20",
        "last_updated": "2013-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• River'S Shore Clinic CTC
• Brenda Esmeralda Rivera Caro, RDN
• Gladys Rivera Hernandez
• Angelique Rivera
• Cecilia Rivera, R.N.
• Jessica Marie Rojo Rivera, FNP-BC
• Kevin A Rivera, MA, MD
• Lauren Rivera
• Luis Alfredo Rivera Jr., P.T.
• Marely Rivera

• Dentist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.