MEDICARE: DR. LILIAN DE LAOSA DMD

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	1223G0001X	General Practice Dentistry	1604	PR

General Provider Information

NPI Number	:	1487756904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILIAN DE LAOSA DMD

Provider Business Mailing Address
First Line	:	F5 CALLE LA CASA BLANCA
Second Line	:	PASEO SAN JUAN
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6508
Country	:	US
Telephone Number	:	787-761-3523
Fax Number	:	787-259-7514

Provider Business Practice Location Address
First Line	:	201 AVE DE DIEGO STE 205
Second Line	:	PLAZA SAN FRANCISCO
City	:	SAN JUAN
State	:	PR
Zip	:	00927-5815
Country	:	US
Telephone Number	:	787-764-6138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	07/08/2007

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