Active NPI
Lance Gabriel Rivera
- Pediatric Dentistry
- Waxahachie, TX
National Provider Identifier
1457050163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 41818
- Practice address
- 2171 N Highway 77
Waxahachie, TX 75165-6215 - Phone
- (469) 589-5303
- NPI assigned
- Mar 2, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 41818 | TX | Primary |
Addresses
Primary practice location
2171 N Highway 77
Waxahachie, TX 75165-6215
Mailing address
2750 N Haskell Ave Apt 1314
Dallas, TX 75204-0421
Phone (214) 293-0728
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41818 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753315200000",
"number": "1457050163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2750 N HASKELL AVE APT 1314",
"city": "DALLAS",
"state": "TX",
"postal_code": "752040421",
"telephone_number": "214-293-0728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2171 N HIGHWAY 77",
"city": "WAXAHACHIE",
"state": "TX",
"postal_code": "751656215",
"telephone_number": "469-589-5303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "LANCE",
"middle_name": "GABRIEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-02",
"last_updated": "2025-07-24",
"certification_date": "2025-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "41818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waxahachie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.