Provider Demographics
NPI:1063626299
Name:CARRO PAGAN, MARIA E (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:CARRO PAGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ENCARNITA
Other - Middle Name:
Other - Last Name:CARRO PAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1416 AVE PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-4031
Mailing Address - Country:US
Mailing Address - Phone:787-722-3290
Mailing Address - Fax:787-722-3290
Practice Address - Street 1:1416 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4031
Practice Address - Country:US
Practice Address - Phone:787-722-3290
Practice Address - Fax:787-722-3290
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice