Provider Demographics
NPI:1114985652
Name:CANINO, CARLOS ALFREDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALFREDO
Last Name:CANINO
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:EL MONTE MALL
Mailing Address - Street 2:SUITE 3130
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4257
Mailing Address - Country:US
Mailing Address - Phone:787-751-5187
Mailing Address - Fax:787-763-4675
Practice Address - Street 1:EL MONTE MALL
Practice Address - Street 2:SUITE 3130
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4257
Practice Address - Country:US
Practice Address - Phone:787-751-5187
Practice Address - Fax:787-763-4675
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice