Samuel Raul Rivera, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

31685 Issued in TX

Practice address

3915 W Davis St Ste 160
Conroe, TX 77304-1879

Phone

(936) 760-2800

NPI assigned

Jul 14, 2011

Last updated

Oct 12, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Conroe Dentistry, PC

  dba Lake Conroe Dentistry

  • Dentist
  • Conroe, TX
  • NPI 1457790982
  NPD (past)

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

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1114215902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33978 PINEHURST DR",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923996934",
            "telephone_number": "714-650-3589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 W DAVIS ST STE 160",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773041879",
            "telephone_number": "936-760-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "SAMUEL",
        "middle_name": "RAUL",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-14",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "60493",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "31685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Riggs, M.S., CCC-SLP
• Right Way Transportation
• Lauren Riley, OTR/L
• Rise and Shine Education & Counseling Enterprises, PLLC (Iesha Sylvester)
• River Oaks Endoscopy LLP
• Rivershire Operations, LLC (Elmcroft of Rivershire)
• Hira Rizvi, MD
• Rmac Village Pharmacy Dba Village Pharmacy
• RNL Berwick Im
• Lauren Robbins, OTR

• General Practice Dentistry in Conroe, TX
• Providers in Conroe, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.