Provider Demographics
NPI:1740512532
Name:CANIZARES, RICHARD (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:CANIZARES
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 1:2023 CARR. 177 CONDOMINIUM LA CORUNA APT 1503
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5175
Mailing Address - Country:US
Mailing Address - Phone:787-594-0944
Mailing Address - Fax:
Practice Address - Street 1:2023 CARR. 177 CONDOMINIUM LA CORUNA APT 1503
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5175
Practice Address - Country:US
Practice Address - Phone:787-594-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2835122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics