Healthcare Provider Details

I. General information

NPI: 1053467134
Provider Name (Legal Business Name): CARLOS J ROBLES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRUCE DAVILA CARR. #2
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 140477
ARECIBO PR
00614-0477
US

V. Phone/Fax

Practice location:
  • Phone: 787-970-0000
  • Fax:
Mailing address:
  • Phone: 787-970-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2456
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier042038
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerCRUZ AZUL DENTAL PLAN
# 2
Identifier206962
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPREFERED HEALTH DENTAL
# 3
Identifier42416
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerTRIPLE S DENTAL PLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: