Healthcare Provider Details

I. General information

NPI: 1245295815
Provider Name (Legal Business Name): PABLO R AMADOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ESCOBAR AVE
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 477
BARCELONETA PR
00617
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-5010
  • Fax: 787-846-5010
Mailing address:
  • Phone: 787-898-3337
  • Fax: 787-846-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number902
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: