MEDICARE: DR. ERIC D. FRONTERA ROURA D.M.D.

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	1091	PR

General Provider Information

NPI Number	:	1992789333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC D. FRONTERA ROURA D.M.D.

Provider Business Mailing Address
First Line	:	7 CALLE MARIO BRASCHI
Second Line	:	P.O.BOX 89
City	:	COAMO
State	:	PR
Zip	:	00769-2501
Country	:	US
Telephone Number	:	787-825-1164
Fax Number	:	787-825-3647

Provider Business Practice Location Address
First Line	:	7 CALLE MARIO BRASCHI
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2501
Country	:	US
Telephone Number	:	787-825-1164
Fax Number	:	787-825-3647

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	10/26/2016

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