Jessup Dental Associates T/a Blank Rivera PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7902 Issued in MD

Legal business name

JESSUP DENTAL ASSOCIATES T/A BLANK RIVERA PA

Practice address

8182 Lark Brown Rd
Suite 101
Elkridge, MD 21075-6420

Phone

(410) 799-2692

Fax

(410) 799-3931

NPI assigned

May 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Emilio Enrique Rivera, DDS

Title

President

Phone

(410) 799-2692

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154374676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8182 LARK BROWN RD",
            "address_2": "SUITE 101",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210756420",
            "telephone_number": "410-799-2692",
            "fax_number": "410-799-3931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8182 LARK BROWN RD",
            "address_2": "SUITE 101",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210756420",
            "telephone_number": "410-799-2692",
            "fax_number": "410-799-3931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSUP DENTAL ASSOCIATES T/A BLANK RIVERA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "EMILIO",
        "authorized_official_middle_name": "ENRIQUE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-799-2692",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "7902",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "8363",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.