Provider Demographics
NPI:1104835172
Name:ALCOBA, RAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:ALCOBA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7304
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7304
Mailing Address - Country:US
Mailing Address - Phone:787-743-8480
Mailing Address - Fax:787-743-8480
Practice Address - Street 1:G34 AVE PINO
Practice Address - Street 2:VILLA TURABO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6145
Practice Address - Country:US
Practice Address - Phone:787-743-8480
Practice Address - Fax:787-743-8480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice