Healthcare Provider Details

I. General information

NPI: 1063435519
Provider Name (Legal Business Name): PEDRO J ANDUJAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA FUENTE TOWN CENTER 706 CALLE MARGINAL STE.#11136
GUAYAMA PR
00784
US

IV. Provider business mailing address

GUARAGUAO #231 SABANERA DEL RIO
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-2857
  • Fax: 787-866-4315
Mailing address:
  • Phone: 787-744-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number1678
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: