Basic Information
Provider Information
NPI: 1124414784
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARIAS BERRIOS
FirstName: JAVIER
MiddleName: EDUARDO
NamePrefix: DR.
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 675 CALLE CUEVAS BUSTAMANTE
Address2: APT SPH8
City: SAN JUAN
State: PR
PostalCode: 009184097
CountryCode: US
TelephoneNumber: 7874474626
FaxNumber: 7877857277
Practice Location
Address1: 103 CALLE AUTONOMIA
Address2: URB. MONTEHIEDRA
City: CANOVANAS
State: PR
PostalCode: 007293297
CountryCode: US
TelephoneNumber: 7878762100
FaxNumber: 7878762100
Other Information
ProviderEnumerationDate: 04/10/2015
LastUpdateDate: 10/03/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X3225PRY Dental ProvidersDentistGeneral Practice

No ID Information.


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