Provider Demographics
NPI:1275675761
Name:SUAREZ, INES RUSSO (DMD)
Entity Type:Individual
Prefix:DR
First Name:INES
Middle Name:RUSSO
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:INES
Other - Middle Name:RUSSO
Other - Last Name:SUAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:MIGRANT HEALTH CENTER, INC.
Mailing Address - Street 2:P O BOX 7128
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7128
Mailing Address - Country:US
Mailing Address - Phone:787-805-2900
Mailing Address - Fax:787-834-1924
Practice Address - Street 1:MIGRANT HEALTH CENTER, INC.
Practice Address - Street 2:392 SUR CARR RAMON EMETERIO BETANCES
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-805-2900
Practice Address - Fax:787-834-1924
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1187OtherNUM COLEGIADO