Provider Demographics
NPI:1821154493
Name:CARABALLO, ABIGAIL (DMD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:CARABALLO
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 1180
Mailing Address - Street 2:CALLE MORSE #79
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714
Mailing Address - Country:US
Mailing Address - Phone:787-839-7059
Mailing Address - Fax:787-839-7089
Practice Address - Street 1:CALLE MORSE #79
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-839-7059
Practice Address - Fax:787-839-7089
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist