Healthcare Provider Details

I. General information

NPI: 1255696340
Provider Name (Legal Business Name): PROSTO-DENTAL, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIO AMAZONAS VALLE VERDE BC20
BAYAMON PR
00961
US

IV. Provider business mailing address

TENIENTE CESAR GONZALEZ 568
HATO REY PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-5998
  • Fax:
Mailing address:
  • Phone: 787-758-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number2756
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS ALBERTO TORRES
Title or Position: PROSTODONTICS
Credential: D.M.D
Phone: 787-758-3804