Provider Demographics
NPI:1205904182
Name:AVILES AVILES, MARIE ROSA (DMD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ROSA
Last Name:AVILES AVILES
Suffix:
Gender:F
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 897
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0897
Mailing Address - Country:US
Mailing Address - Phone:787-797-0550
Mailing Address - Fax:787-799-2100
Practice Address - Street 1:TOA ALTA HEIGHTS MINI MALL
Practice Address - Street 2:AVE. PRINCIPAL BLQ. M1-D
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-0897
Practice Address - Country:US
Practice Address - Phone:787-797-0550
Practice Address - Fax:787-799-2110
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice