Provider Demographics
NPI:1689716433
Name:CARVAJAL, IRVING NICOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:NICOLAS
Last Name:CARVAJAL
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 1:10114 SW 107 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-273-1648
Mailing Address - Fax:305-273-9589
Practice Address - Street 1:10114 SW 107 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-273-1648
Practice Address - Fax:305-273-9589
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist