Provider Demographics
NPI:1942348636
Name:NIEVES, ROBERTO E (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:E
Last Name:NIEVES
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:PO BOX 2025
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-2025
Mailing Address - Country:US
Mailing Address - Phone:787-762-4629
Mailing Address - Fax:787-276-6531
Practice Address - Street 1:CARRETERA # 3 K.M. 11.7
Practice Address - Street 2:PLAZA GUZMAN - MARGINAL LOMAS DE CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-762-4629
Practice Address - Fax:787-276-6531
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice