Provider Demographics
NPI:1609874825
Name:CLAVELL, CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:CLAVELL
Suffix:
Gender:M
Credentials:DDS
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 6424
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6424
Mailing Address - Country:US
Mailing Address - Phone:787-826-1178
Mailing Address - Fax:787-826-5260
Practice Address - Street 1:67 CALLE 65 INFANTERIA
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2909
Practice Address - Country:US
Practice Address - Phone:787-826-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice