Healthcare Provider Details

I. General information

NPI: 1568427268
Provider Name (Legal Business Name): ILEANE AMADOR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ESCOBAR #13
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 3994
AGUADILLA PR
00605
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-5010
  • Fax: 787-846-5010
Mailing address:
  • Phone: 787-356-2080
  • Fax: 787-846-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2609
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: