Provider Demographics
NPI:1861508806
Name:SUAREZ, RAFAEL ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:SUAREZ
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 1:552 CALLE TRIGO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2512
Mailing Address - Country:US
Mailing Address - Phone:787-725-5646
Mailing Address - Fax:
Practice Address - Street 1:701 PONCE DE LEON AVE.
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:SANJUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1225
Practice Address - Country:US
Practice Address - Phone:787-725-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice