Provider Demographics
NPI:1023037314
Name:AREVALO, CAROLINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:AREVALO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 112TH ST
Mailing Address - Street 2:APT 6-O
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5561
Mailing Address - Country:US
Mailing Address - Phone:718-355-8851
Mailing Address - Fax:
Practice Address - Street 1:11120 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-4016
Practice Address - Country:US
Practice Address - Phone:718-206-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0511731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice