Provider Demographics
NPI:1538353222
Name:CARIBBEAN DENTAL ASSOCIATES
Entity type:Organization
Organization Name:CARIBBEAN DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:DARIO
Authorized Official - Last Name:MORONTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-292-8966
Mailing Address - Street 1:509 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4001
Mailing Address - Country:US
Mailing Address - Phone:718-292-8966
Mailing Address - Fax:
Practice Address - Street 1:509 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4001
Practice Address - Country:US
Practice Address - Phone:718-292-8966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02154974Medicaid