MEDICARE: DR. GRACIELA ROSARIO 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	122300000X	Dentist	1267	PR

General Provider Information

NPI Number	:	1942200167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACIELA ROSARIO DMD

Provider Business Mailing Address
First Line	:	PO BOX 2055
Second Line	:
City	:	AIBONITO
State	:	PR
Zip	:	00705-2055
Country	:	US
Telephone Number	:	787-735-5999
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE PEDRO ROSARIO
Second Line	:	SUITE K-11
City	:	AIBONITO
State	:	PR
Zip	:	00705-2055
Country	:	US
Telephone Number	:	787-735-5999
Fax Number	:

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/29/2015

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