MEDICARE: DR. VICTOR L ACEVEDO DMD,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	864	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42261	OTHER	PR	TRIPLE S, INC
2	040376	OTHER	PR	CRUZ AZUL DE PR
3	8817007	OTHER	PR	UNITED CONCORDIA

General Provider Information

NPI Number	:	1033212501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR L ACEVEDO DMD,MS

Provider Business Mailing Address
First Line	:	LOS FLAMBOYANES SHOPPING CTR
Second Line	:	OF.12, 65TH DE INFANTERIA
City	:	SAN JUAN
State	:	PR
Zip	:	00923-3306
Country	:	US
Telephone Number	:	787-758-1560
Fax Number	:	787-758-1513

Provider Business Practice Location Address
First Line	:	LOS FLAMBOYANES SHOPPING CTR
Second Line	:	OF.12, 65TH DE INFANTERIA
City	:	SAN JUAN
State	:	PR
Zip	:	00923-3306
Country	:	US
Telephone Number	:	787-758-1560
Fax Number	:	787-758-1513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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