Healthcare Provider Details

I. General information

NPI: 1730549106
Provider Name (Legal Business Name): QUALITY ENDODONTICS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89-1 CALLE 99 AVENIDA ROBERTO CLEMENTE
CAROLINA PR
00985
US

IV. Provider business mailing address

1 CONDOMINIO CORAL BEACH APT 910
CAROLINA PR
00979
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-0548
  • Fax:
Mailing address:
  • Phone: 787-553-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3175
License Number StatePR

VIII. Authorized Official

Name: DR. RICKY GONZALEZ
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-553-2738