Healthcare Provider Details

I. General information

NPI: 1780791244
Provider Name (Legal Business Name): TERESA J. IRIZARRY-CARO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CAMINO ALEJANDRINO VILLA CLEMENTINA
GUAYNABO PR
00969-4712
US

IV. Provider business mailing address

4 CAMINO ALEJANDRINO VILLA CLEMENTINA
GUAYNABO PR
00969-4712
US

V. Phone/Fax

Practice location:
  • Phone: 787-190-4870
  • Fax: 787-790-1859
Mailing address:
  • Phone: 787-790-4870
  • Fax: 787-790-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1355
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: