Healthcare Provider Details

I. General information

NPI: 1215370044
Provider Name (Legal Business Name): ROC DENTAL SERVICES, P.SC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ROBERTO CLEMENTE 24-8 VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

AVE. ROBERTO CLEMENTE 24-8 VILLA CAROLINA
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-3080
  • Fax: 787-757-3080
Mailing address:
  • Phone: 787-757-3080
  • Fax: 787-757-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: IVELISSE SANTIAGO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-757-3080