Provider Demographics
NPI:1528158078
Name:COLON-BLANCO, ROBERTO A II (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:A
Last Name:COLON-BLANCO
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:A
Other - Last Name:COLON-BLANCO
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0945
Mailing Address - Country:US
Mailing Address - Phone:787-376-5520
Mailing Address - Fax:787-857-5010
Practice Address - Street 1:111 CALLE FCO GONZALO MARIN
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4754
Practice Address - Country:US
Practice Address - Phone:787-878-3661
Practice Address - Fax:787-878-3661
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice