Provider Demographics
NPI:1477682433
Name:MAESO, OSVALDO MIGUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:MIGUEL
Last Name:MAESO
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 1:3518 AVE. SUR APT. 10-12
Mailing Address - Street 2:THE RESIDENCES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-776-2841
Mailing Address - Fax:
Practice Address - Street 1:845 CALLE MOLUCAS
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-1755
Practice Address - Country:US
Practice Address - Phone:787-757-1085
Practice Address - Fax:787-757-1405
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist