Healthcare Provider Details

I. General information

NPI: 1285935239
Provider Name (Legal Business Name): ECG DENTISTRY P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE RD 3 KM 8.40 BARRIO MARTIN GONZALES #107 PASEO DEL PRADO SHOPPING CENTER
CAROLINA PR
00985
US

IV. Provider business mailing address

STATE RD 3 KM 8.40 BARRIO MARTIN GONZALES #107 PASEO DEL PRADO SHOPPING CENTER
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-5450
  • Fax: 787-276-5452
Mailing address:
  • Phone: 787-276-5450
  • Fax: 787-276-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ELLEN COLON GOTAY
Title or Position: OWNER
Credential: DDS
Phone: 787-276-5450