Healthcare Provider Details

I. General information

NPI: 1790892255
Provider Name (Legal Business Name): ROBERTO HERNANDEZ-ORSINI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CAMINO ALEJANDRINO VILLA CLEMENTINA
GUAYNABO PR
00969-4712
US

IV. Provider business mailing address

4 CAMINO ALEJANDRINO VILLA CLEMENTINA
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-731-8424
  • Fax: 787-790-1859
Mailing address:
  • Phone: 787-731-8424
  • Fax: 787-790-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1354
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: