Healthcare Provider Details

I. General information

NPI: 1003648668
Provider Name (Legal Business Name): SKY ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 AVE MONSERRATE
CAROLINA PR
00983
US

IV. Provider business mailing address

4 COND SAN FERNANDO VLG APT 327
CAROLINA PR
00987-6964
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-2886
  • Fax:
Mailing address:
  • Phone: 787-485-9142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC TORRES
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-485-9142