Provider Demographics
NPI:1386050466
Name:CALERO DOITTEAU, JAVIER (DMD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:CALERO DOITTEAU
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 194522
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4522
Mailing Address - Country:US
Mailing Address - Phone:939-644-3866
Mailing Address - Fax:
Practice Address - Street 1:PLAZA DEL CARMEN MALL
Practice Address - Street 2:LOCAL #22, CARR #172 INT CARR #1
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038556400Medicaid