Provider Demographics
NPI:1558417444
Name:ROLON, CLELIA (DMD)
Entity Type:Individual
Prefix:
First Name:CLELIA
Middle Name:
Last Name:ROLON
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:A6 CALLE CALIFORNIA
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1833
Mailing Address - Country:US
Mailing Address - Phone:787-895-2343
Mailing Address - Fax:787-895-2343
Practice Address - Street 1:A6 CALLE CALIFORNIA
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-1833
Practice Address - Country:US
Practice Address - Phone:787-895-2343
Practice Address - Fax:787-895-2343
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice