Provider Demographics
NPI:1194717496
Name:COLON, MIRELIS NYVETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:MIRELIS
Middle Name:NYVETTE
Last Name:COLON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MIRELIS
Other - Middle Name:NYVETTE
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0165
Mailing Address - Country:US
Mailing Address - Phone:787-869-2565
Mailing Address - Fax:787-869-2471
Practice Address - Street 1:REAL SHOPPING CENTER
Practice Address - Street 2:AVE. ALBOLOTE # 1 SUITE 105
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-400-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26751223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice