Healthcare Provider Details

I. General information

NPI: 1487861704
Provider Name (Legal Business Name): DENTALIA MEDIKA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 857 0.4 BO CANOVANILLAS
CAROLINA PR
00987
US

IV. Provider business mailing address

PO BOX 800
CAROLINA PR
00986-0800
US

V. Phone/Fax

Practice location:
  • Phone: 787-776-3840
  • Fax: 787-276-2923
Mailing address:
  • Phone: 787-776-3840
  • Fax: 787-276-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RAFAEL ORTIZ PIETRI
Title or Position: DUENO
Credential: MD
Phone: 787-776-3840