Provider Demographics
NPI:1205822582
Name:ALVAREZ, EDWIN (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. QUINTAS DE CABO ROJO
Mailing Address - Street 2:# 162 CALLE CISNE
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-255-0727
Mailing Address - Fax:787-255-0879
Practice Address - Street 1:40 CALLE CARBONELL
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3445
Practice Address - Country:US
Practice Address - Phone:787-255-0727
Practice Address - Fax:787-255-0879
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD-22811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics