Provider Demographics
NPI:1538163951
Name:ACEVEDO, SERGIO (DMD)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:ACEVEDO
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 1:256 CALLE PAZ
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2939
Mailing Address - Country:US
Mailing Address - Phone:787-868-3190
Mailing Address - Fax:787-868-3190
Practice Address - Street 1:256 CALLE PAZ
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-2939
Practice Address - Country:US
Practice Address - Phone:787-868-3190
Practice Address - Fax:787-868-3190
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice