Healthcare Provider Details

I. General information

NPI: 1982917597
Provider Name (Legal Business Name): PEDIATRIC & GENERAL DENTAL SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AA10 AVE SANTA JUANITA
BAYAMON PR
00956-4644
US

IV. Provider business mailing address

AA10 AVE SANTA JUANITA
BAYAMON PR
00956-4644
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5595
  • Fax: 787-779-0663
Mailing address:
  • Phone: 787-787-5595
  • Fax: 787-779-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number197900
License Number StatePR

VIII. Authorized Official

Name: DR. DALMA ESTHER TORRES
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-787-5595