Healthcare Provider Details

I. General information

NPI: 1871668459
Provider Name (Legal Business Name): LUIS RAMON SANTOS-RIVERA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD NUM. 2 - KM 57.2 -CRUCE DAVILA
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 758
ARECIBO PR
00613-0758
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-5215
  • Fax: 787-846-5215
Mailing address:
  • Phone: 787-878-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number968
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: