Provider Demographics
NPI:1508952227
Name:FIDALGO ALVARADO, CARLA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:M
Last Name:FIDALGO ALVARADO
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:CARR. 844 COND. CAMINOS VERDES APT 1205
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-459-2500
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS CABALLER #1213 ESQ. CARMEN HERNANDEZ
Practice Address - Street 2:EL COMANDANTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-769-1990
Practice Address - Fax:787-762-5890
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice