Healthcare Provider Details

I. General information

NPI: 1740472182
Provider Name (Legal Business Name): SONRISAS DE ARECIBO, C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CALLE GONZALO MARIN
ARECIBO PR
00612-4754
US

IV. Provider business mailing address

PO BOX 945
ARECIBO PR
00613-0945
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-3661
  • Fax: 787-878-3754
Mailing address:
  • Phone: 787-878-3661
  • Fax: 787-878-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2747
License Number StatePR

VIII. Authorized Official

Name: DR. ROBERTO A COLON-BLANCO JR.
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 787-878-3661