Provider Demographics
NPI:1649324864
Name:RIOS ROLDAN, AIDA M (DMD)
Entity type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:M
Last Name:RIOS ROLDAN
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 270269
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-0269
Mailing Address - Country:US
Mailing Address - Phone:787-720-1625
Mailing Address - Fax:
Practice Address - Street 1:2T1 EMILIANO POL AVE
Practice Address - Street 2:URB LA CUMBRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-720-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9260015OtherHUMANA
PR41300OtherTRIPLE S
PR41052OtherCRUZ AZUL
206551OtherUTI OF PR