MEDICARE: DR. MARIA TERESA CADILLA 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	1981	PR

General Provider Information

NPI Number	:	1659422442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA TERESA CADILLA DMD

Provider Business Mailing Address
First Line	:	PASEO MAYOR CALLE 5 A - 14
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-755-2903
Fax Number	:	787-293-0266

Provider Business Practice Location Address
First Line	:	IA5 AVE LOMAS VERDES
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00956-3133
Country	:	US
Telephone Number	:	787-798-6080
Fax Number	:	787-995-0459

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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