MEDICARE: WESTERN DENTAL P.S.C.

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	3201	PR

General Provider Information

NPI Number	:	1598116311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN DENTAL P.S.C.

Provider Business Mailing Address
First Line	:	HC 5 BOX 15552
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-9649
Country	:	US
Telephone Number	:	787-439-5728
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 CALLE LA PAZ
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602-2939
Country	:	US
Telephone Number	:	787-868-3190
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUAN GILBERTO SANCHEZ
Credential	:
Telephone Number	:	787-439-5728

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	06/22/2016

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