Provider Demographics
NPI:1013969062
Name:CANDELARIA, CARLOS B (DMD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:B
Last Name:CANDELARIA
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:P.O BOX 4952
Mailing Address - Street 2:PMB 132
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-258-4090
Mailing Address - Fax:787-745-3275
Practice Address - Street 1:I - 20 LUIS MUNOZ MARIN
Practice Address - Street 2:VILLA CARMEN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-258-4090
Practice Address - Fax:787-745-3275
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice