MEDICARE: FC TITANIUM PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1225451305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FC TITANIUM PSC

Provider Business Mailing Address
First Line	:	BAYAMON GARDENS
Second Line	:	BB12 C STREET
City	:	BAYAMON
State	:	PR
Zip	:	00957-2467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	BAYAMON GARDENS
Second Line	:	BB12 C STREET
City	:	BAYAMON
State	:	PR
Zip	:	00957-2467
Country	:	US
Telephone Number	:	787-409-4295
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARLOS ANTONIO IZCOA
Credential	:	DMD
Telephone Number	:	787-409-4295

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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