Most Relevant Information
Provider Data
| NPI Number: | 1003591215 |
| Provider Name: | JONATHON RIVERA D.M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 28159 |
Most Important Dates
| Enumeration Date: | 06/16/2023 |
| Last Updated: | 06/16/2023 |
Provider Practice Location
701 STATE ROAD 60 E
LAKE WALES
FL
338534240
Practice Location Phone/Fax
| Phone: | 8636766021 |
| Fax: |
Provider Mailing Location
701 STATE ROAD 60 E
LAKE WALES
FL
338534240
Provider Mailing Phone/Fax
| Phone: | 8636766021 |
| Fax: |