Individual provider Active NPI

Marie Rosa Aviles Aviles, DMD

  • General Practice Dentistry
  • Toa Alta, PR
National Provider Identifier
1205904182
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1886 Issued in PR
Practice address
Toa Alta Heights Mini Mall
Ave. Principal BLQ. M1-D
Toa Alta, PR 00953-0897
Phone
(787) 797-0550
Fax
(787) 799-2110
NPI assigned
Dec 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1886 PR Primary

Addresses

Primary practice location

Toa Alta Heights Mini Mall
Ave. Principal BLQ. M1-D
Toa Alta, PR 00953-0897

Mailing address

PO Box 897
Bayamon, PR 00960-0897
Phone (787) 797-0550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160615001424 PR Order and Referring Only - DentistPractitioner - Dentist 4688965015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1886PRMDRegistered Dietitian

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205904182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 897",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009600897",
            "telephone_number": "787-797-0550",
            "fax_number": "787-799-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "TOA ALTA HEIGHTS MINI MALL",
            "address_2": "AVE. PRINCIPAL BLQ. M1-D",
            "city": "TOA ALTA",
            "state": "PR",
            "postal_code": "009530897",
            "telephone_number": "787-797-0550",
            "fax_number": "787-799-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVILES AVILES",
        "first_name": "MARIE",
        "middle_name": "ROSA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "1886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toa Alta, PR

Sources for this page

Verify at the official NPI Registry.