Provider Demographics
NPI:1801880950
Name:AVILES, MARCIANO E (DMD)
Entity type:Individual
Prefix:DR
First Name:MARCIANO
Middle Name:E
Last Name:AVILES
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 201
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0201
Mailing Address - Country:US
Mailing Address - Phone:787-896-1265
Mailing Address - Fax:787-280-0171
Practice Address - Street 1:4100 AVE ARCADIO ESTRADA
Practice Address - Street 2:STE 110 SAN SEBASTIAN OFFICE BUILDING
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3216
Practice Address - Country:US
Practice Address - Phone:787-896-1265
Practice Address - Fax:787-280-0171
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist