=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316710718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARIBE SMILES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2023
-----------------------------------------------------
Last Update Date | 11/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 CALLE ALBERTO RICCI
-----------------------------------------------------
City | PATILLAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-316-4545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 CALLE ALBERTO RICCI
-----------------------------------------------------
City | PATILLAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-316-4545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYEE/PRESIDENT
-----------------------------------------------------
Name | DR. CAROLINA A BELLO RIVERA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 787-316-4545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------