Angel F. Aviles Ramos, DMD

Individual provider Active NPI Dentist · Aibonito, PR

NPI 1265403083 · NPPES record last updated Dec 16, 2011

Key facts

NPI
1265403083
Entity type
Individual (NPI type 1)
Primary specialty
Dentist 122300000X
License
#053810 (NY)
Practice address
San Jose #155
Aibonito, PR 00705-0000
Phone
(787) 735-7960
Fax
(787) 735-7960
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20151015000317 PR Order and Referring Only - Oral Surgery
Practitioner - Oral Surgery
7517276496

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
#053810NYMDDentist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 1191 PR
Dentist 122300000X #053810 NY Yes

Addresses

Primary practice location

San Jose #155
Aibonito, PR 00705-0000

Mailing address

P.O. Box 1507
Aibonito, PR 00705-1507
Phone (787) 735-7960

Other identifiers

IdentifierTypeStateIssuer
1191OtherPRSTATE LICENSE

Other providers in Aibonito, PR

All providers in Aibonito, PR · Dentist in Puerto Rico

Sources for this page

Verify at the official NPI Registry.