George Michael Riviere, DDS
Individual provider Active NPI Dentist · Le Center, MN
NPI 1508847435 · NPPES record last updated Jun 10, 2014
Key facts
- NPI
- 1508847435
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8570 (MN)
- Practice address
- 34 N Park Ave
Le Center, MN 56057-1511 - Phone
- (507) 357-4833
- Fax
- (507) 357-4833
- NPI assigned
- Nov 8, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8570 | MN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8570 | MN | Yes |
Addresses
Primary practice location
34 N Park Ave
Le Center, MN 56057-1511
Mailing address
34 N Park Ave
Le Center, MN 56057-1511
Phone (507) 357-4833
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 351718700 | Other | MN | MEDICAL ASSISTANCE |
Other providers in Le Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.