Healthcare Provider Details

I. General information

NPI: 1942126628
Provider Name (Legal Business Name): NOVA DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 181 KM 22.9 BO CELADA LOCAL 4 EDIF SOTERO GOMEZ
GURABO PR
00778
US

IV. Provider business mailing address

PO BOX 1104
GURABO PR
00778-1104
US

V. Phone/Fax

Practice location:
  • Phone: 787-712-8857
  • Fax:
Mailing address:
  • Phone: 787-712-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: REYNALDO ROSA
Title or Position: DENTISTA
Credential: DMD
Phone: 787-712-8857