Provider Demographics
NPI:1841475944
Name:AVILES, ROSARIO MEDINA
Entity type:Individual
Prefix:DR
First Name:ROSARIO
Middle Name:MEDINA
Last Name:AVILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSIE
Other - Middle Name:
Other - Last Name:AVILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:870 SW MARTIN DOWNS BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2855
Mailing Address - Country:US
Mailing Address - Phone:772-287-8181
Mailing Address - Fax:772-287-3797
Practice Address - Street 1:870 SW MARTIN DOWNS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2855
Practice Address - Country:US
Practice Address - Phone:772-287-8181
Practice Address - Fax:772-287-3797
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 127511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics