Healthcare Provider Details

I. General information

NPI: 1992700264
Provider Name (Legal Business Name): ALFREDO ANTONIO CANINO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 AVE DE DIEGO
ARECIBO PR
00612-4358
US

IV. Provider business mailing address

PO BOX 140669
ARECIBO PR
00614-0669
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-2813
  • Fax: 787-817-7534
Mailing address:
  • Phone: 787-878-2813
  • Fax: 787-817-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0581
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: