Provider Demographics
NPI:1326011990
Name:CARLO, VICTOR M (DMD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:CARLO
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:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1008
Mailing Address - Country:US
Mailing Address - Phone:787-255-3838
Mailing Address - Fax:
Practice Address - Street 1:DA35 URB LA MARGARITA
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2707
Practice Address - Country:US
Practice Address - Phone:787-842-1002
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8189Medicare UPIN