Provider Demographics
NPI:1295825339
Name:VARELA, JORGE ALBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALBERTO
Last Name:VARELA
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:TORRE DE PLAZA LAS AMERICAS 525FDR
Mailing Address - Street 2:SUITE 609
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1312
Mailing Address - Country:US
Mailing Address - Phone:787-763-5503
Mailing Address - Fax:
Practice Address - Street 1:TORRE DE PLAZA LAS AMERICAS 525FDR
Practice Address - Street 2:SUITE 609
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1312
Practice Address - Country:US
Practice Address - Phone:787-763-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR2329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPR2329OtherSTATE LICENCE