Provider Demographics
NPI:1588878615
Name:TACORONTE, WILFREN (DDS)
Entity type:Individual
Prefix:DR
First Name:WILFREN
Middle Name:
Last Name:TACORONTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 CALLE MUNOZ RIVERA W
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-2128
Mailing Address - Country:US
Mailing Address - Phone:787-823-8888
Mailing Address - Fax:
Practice Address - Street 1:46 CALLE MUNOZ RIVERA W
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2128
Practice Address - Country:US
Practice Address - Phone:787-823-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist