Provider Demographics
NPI:1386711745
Name:CARDONA, ALVIN ARIEL SR (DMD)
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:ARIEL
Last Name:CARDONA
Suffix:SR
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:MEDICAL OPHTALMIC PLAZA
Mailing Address - Street 2:SUITE 202 CARR #2 KM 119
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-787-5147
Mailing Address - Fax:787-269-7885
Practice Address - Street 1:MEDICAL OPHTALMIC PLAZA
Practice Address - Street 2:SUITE 202 CARR #2 KM 119
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-5147
Practice Address - Fax:787-269-7885
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist