MEDICARE: CARLOS CLAVELL 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	1183	PR

General Provider Information

NPI Number	:	1609874825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS CLAVELL DDS

Provider Business Mailing Address
First Line	:	PO BOX 6424
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-6424
Country	:	US
Telephone Number	:	787-826-1178
Fax Number	:	787-826-5260

Provider Business Practice Location Address
First Line	:	67 CALLE 65 INFANTERIA
Second Line	:
City	:	ANASCO
State	:	PR
Zip	:	00610-2909
Country	:	US
Telephone Number	:	787-826-1178
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/04/2012

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