MEDICARE: DR. CAROLINE AREVALO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	051173	NY

General Provider Information

NPI Number	:	1023037314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE AREVALO DDS

Provider Business Mailing Address
First Line	:	7272 112TH ST
Second Line	:	APT 6-O
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5561
Country	:	US
Telephone Number	:	718-355-8851
Fax Number	:

Provider Business Practice Location Address
First Line	:	11120 MERRICK BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-4016
Country	:	US
Telephone Number	:	718-206-9888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/24/2015

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