MEDICARE: DR. SERGIO ACEVEDO D.M.D.

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	605	PR

General Provider Information

NPI Number	:	1538163951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGIO ACEVEDO D.M.D.

Provider Business Mailing Address
First Line	:	256 CALLE PAZ
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602-2939
Country	:	US
Telephone Number	:	787-868-3190
Fax Number	:	787-868-3190

Provider Business Practice Location Address
First Line	:	256 CALLE PAZ
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602-2939
Country	:	US
Telephone Number	:	787-868-3190
Fax Number	:	787-868-3190

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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