MEDICARE: VICTOR M CARLO DMD

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	1223G0001X	General Practice Dentistry	2217	PR

General Provider Information

NPI Number	:	1326011990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR M CARLO DMD

Provider Business Mailing Address
First Line	:	PO BOX 1008
Second Line	:
City	:	CABO ROJO
State	:	PR
Zip	:	00623-1008
Country	:	US
Telephone Number	:	787-255-3838
Fax Number	:

Provider Business Practice Location Address
First Line	:	DA35 URB LA MARGARITA
Second Line	:
City	:	SALINAS
State	:	PR
Zip	:	00751-2707
Country	:	US
Telephone Number	:	787-842-1002
Fax Number	:

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	03/07/2016

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