Healthcare Provider Details

I. General information

NPI: 1851595987
Provider Name (Legal Business Name): ORTHODONTICS UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANTONIO R. BARCELO ST. #20 SIERRA DE CAYEY PLAZA SUITE 207
CAYEY PR
00736
US

IV. Provider business mailing address

PO BOX 7859
CAGUAS PR
00726-7859
US

V. Phone/Fax

Practice location:
  • Phone: 787-263-7500
  • Fax: 787-263-8335
Mailing address:
  • Phone: 787-263-7500
  • Fax: 787-263-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1003
License Number StatePR

VIII. Authorized Official

Name: DR. EUSEBIO A DIAZ
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-263-7500