Healthcare Provider Details

I. General information

NPI: 1720751548
Provider Name (Legal Business Name): ADVANCED ENDODONTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA TROPICAL #11 CARR 167 KM. 22.2
BAYAMON PR
00959
US

IV. Provider business mailing address

PLAZA TROPICAL #11 CARR 167 KM. 22.2
BAYAMON PR
00959-9998
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-1340
  • Fax: 787-641-0804
Mailing address:
  • Phone: 787-641-1340
  • Fax: 787-641-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. SEBASTIAN ANDRES RODRIGUEZ
Title or Position: PRESIDENTE
Credential: DMD
Phone: 787-641-1340