Provider Demographics
NPI:1952622185
Name:SUAREZ, CARLOS (DN)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HEFFERNAN AVE
Mailing Address - Street 2:PMB 45092
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2736
Mailing Address - Country:US
Mailing Address - Phone:760-427-3607
Mailing Address - Fax:
Practice Address - Street 1:130 HEFFERNAN AVE
Practice Address - Street 2:PMB 45092
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2736
Practice Address - Country:US
Practice Address - Phone:760-427-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63957111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice