Provider Demographics
NPI:1932510211
Name:VERA-CARABALLO, LIONEL NOEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:NOEL
Last Name:VERA-CARABALLO
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 1:37 TRIANGLE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-3371
Mailing Address - Country:US
Mailing Address - Phone:596-602-9500
Mailing Address - Fax:
Practice Address - Street 1:37 TRIANGLE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-3371
Practice Address - Country:US
Practice Address - Phone:845-292-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT124241223P0221X
NY0589241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry