Healthcare Provider Details

I. General information

NPI: 1871315440
Provider Name (Legal Business Name): SERVICIOS DENTALES ESPECIALIZADOS, C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 AVE ALEJANDRINO
GUAYNABO PR
00969-4712
US

IV. Provider business mailing address

4 AVE ALEJANDRINO
GUAYNABO PR
00969-4712
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 Number
License Number State

VIII. Authorized Official

Name: DR. ROBERTO HERNANDEZ
Title or Position: ORTODONCISTA
Credential: DMD, MPH, MS
Phone: 787-731-8424