Healthcare Provider Details

I. General information

NPI: 1134629165
Provider Name (Legal Business Name): LECM ORTHO GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 AVE PEDRO ALBIZU CAMPOS
AGUADILLA PR
00603-5723
US

IV. Provider business mailing address

PO BOX 39
AGUADILLA PR
00605-0039
US

V. Phone/Fax

Practice location:
  • Phone: 787-891-1338
  • Fax: 787-891-2266
Mailing address:
  • Phone: 787-891-1338
  • Fax: 787-891-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS EDGARDO CALDERO
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-891-1338