MEDICARE: DR. DAMARIES CANDELARIOSOTO DMD

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	1223E0200X	Endodontics	DN011492	GA

General Provider Information

NPI Number	:	1033198858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMARIES CANDELARIOSOTO DMD

Provider Business Mailing Address
First Line	:	452 AVE HOSTOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3015
Country	:	US
Telephone Number	:	787-274-8837
Fax Number	:	787-200-6356

Provider Business Practice Location Address
First Line	:	452 AVE HOSTOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3015
Country	:	US
Telephone Number	:	787-274-8837
Fax Number	:	787-200-6356

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/01/2016

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