Provider Demographics
NPI:1902106537
Name:NIEVES MENDEZ, CARLOS MIGUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MIGUEL
Last Name:NIEVES MENDEZ
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:HC 59 BOX 6126
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9659
Mailing Address - Country:US
Mailing Address - Phone:787-363-3000
Mailing Address - Fax:
Practice Address - Street 1:517 CALLE CONCEPCION VERA # A-1
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-5073
Practice Address - Country:US
Practice Address - Phone:787-284-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist