Provider Demographics
NPI:1104823707
Name:MATOS, CARLOS RAFAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RAFAEL
Last Name:MATOS
Suffix:
Gender:M
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:MENDEZ VIGO 13 ESTE
Mailing Address - Street 2:OFIC. 208
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-831-1340
Mailing Address - Fax:787-831-1350
Practice Address - Street 1:MENDEZ VIGO 13 ESTE
Practice Address - Street 2:OFIC. 208
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-1340
Practice Address - Fax:787-831-1350
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice