Provider Demographics
NPI:1013006808
Name:MALDONADO, ROBERTO E (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:E
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3398
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3398
Mailing Address - Country:US
Mailing Address - Phone:787-806-0116
Mailing Address - Fax:
Practice Address - Street 1:CENTRO SERVICIOS MEDICOS
Practice Address - Street 2:STE 5B MEDITACION #55
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-806-0116
Practice Address - Fax:787-806-0116
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD024491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
40013OtherTRIPLE INC
01497021OtherUNITED CONCORDIA
PR100114OtherCRUZ AZUL
PR6800221OtherHUMANA
70449OtherPMC MEDICARE CHOICE
660627713OtherCIGNA
2449OtherPLAN SERVICIOS DE SALUD B