Provider Demographics
NPI:1336317353
Name:CARDONA, YALICE MARIELY (DMD)
Entity Type:Individual
Prefix:DR
First Name:YALICE
Middle Name:MARIELY
Last Name:CARDONA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CALLE GEORGETTI
Mailing Address - Street 2:APT 10
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-5293
Mailing Address - Country:US
Mailing Address - Phone:787-552-2631
Mailing Address - Fax:787-883-2071
Practice Address - Street 1:CARR #2 KM 96.8
Practice Address - Street 2:BO COCOS
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-552-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice