Basic Information
| Provider Information | |||||||||
| NPI: | 1023037314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AREVALO | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7272 112TH ST | ||||||||
| Address2: | APT 6-O | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113755561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183558851 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11120 MERRICK BLVD | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114334016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182069888 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 02/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 051173 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.