Provider Demographics
NPI:1588638175
Name:OCASIO, KIM (DMD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:OCASIO
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0547
Mailing Address - Country:US
Mailing Address - Phone:787-743-5767
Mailing Address - Fax:
Practice Address - Street 1:4 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2687
Practice Address - Country:US
Practice Address - Phone:787-743-5767
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1853Medicare UPIN