Provider Demographics
NPI:1629115399
Name:AVILES, GUILLERMO ENRIQUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ENRIQUE
Last Name:AVILES
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 1:103 CALLE DEGETAU S
Mailing Address - Street 2:P.O BOX 1557
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-3621
Mailing Address - Country:US
Mailing Address - Phone:787-735-7136
Mailing Address - Fax:787-735-7136
Practice Address - Street 1:103 CALLE DEGETAU S
Practice Address - Street 2:APT 3
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1557
Practice Address - Country:US
Practice Address - Phone:787-735-7136
Practice Address - Fax:787-735-7136
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice