Provider Demographics
NPI:1235435553
Name:DELGADO, CARLOS MANUEL (DDS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:DELGADO
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 1:3000 NE 190TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3180
Mailing Address - Country:US
Mailing Address - Phone:305-978-3460
Mailing Address - Fax:
Practice Address - Street 1:3000 NE 190TH ST APT 106
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3180
Practice Address - Country:US
Practice Address - Phone:305-978-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice