Provider Demographics
NPI:1669541587
Name:MEDINA, ARNALDO J (DMD)
Entity type:Individual
Prefix:DR
First Name:ARNALDO
Middle Name:J
Last Name:MEDINA
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:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-0838
Mailing Address - Country:US
Mailing Address - Phone:787-829-2637
Mailing Address - Fax:787-829-2637
Practice Address - Street 1:16 CALLE PROGRESO
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-2266
Practice Address - Country:US
Practice Address - Phone:787-829-2637
Practice Address - Fax:787-829-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice