Healthcare Provider Details

I. General information

NPI: 1326011990
Provider Name (Legal Business Name): VICTOR M CARLO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DA35 URB LA MARGARITA
SALINAS PR
00751-2707
US

IV. Provider business mailing address

PO BOX 1008
CABO ROJO PR
00623-1008
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-1002
  • Fax:
Mailing address:
  • Phone: 787-255-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2217
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: