Provider Demographics
NPI:1932281961
Name:CARPIO, JESUS (DMD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:CARPIO
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 1:230-174 STREET
Mailing Address - Street 2:818
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:305-467-3560
Mailing Address - Fax:
Practice Address - Street 1:5632 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6135
Practice Address - Country:US
Practice Address - Phone:305-625-9777
Practice Address - Fax:305-625-2009
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN162911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice