Provider Demographics
NPI:1649469370
Name:MUDAFORT, ANABELLE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANABELLE
Middle Name:MARIE
Last Name:MUDAFORT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 AVE SAN PATRICIO STE 1210
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3054
Mailing Address - Country:US
Mailing Address - Phone:787-946-0277
Mailing Address - Fax:787-946-0024
Practice Address - Street 1:101 AVE SAN PATRICIO STE 1210
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3054
Practice Address - Country:US
Practice Address - Phone:787-946-0277
Practice Address - Fax:787-946-0024
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry