Provider Demographics
NPI:1033212501
Name:ACEVEDO, VICTOR L (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOS FLAMBOYANES SHOPPING CTR
Mailing Address - Street 2:OF.12, 65TH DE INFANTERIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3306
Mailing Address - Country:US
Mailing Address - Phone:787-758-1560
Mailing Address - Fax:787-758-1513
Practice Address - Street 1:LOS FLAMBOYANES SHOPPING CTR
Practice Address - Street 2:OF.12, 65TH DE INFANTERIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3306
Practice Address - Country:US
Practice Address - Phone:787-758-1560
Practice Address - Fax:787-758-1513
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR42261OtherTRIPLE S, INC
PR040376OtherCRUZ AZUL DE PR
PR8817007OtherUNITED CONCORDIA