Healthcare Provider Details

I. General information

NPI: 1154576783
Provider Name (Legal Business Name): DEL NORTE DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 MARGINAL #556
HATILLO PR
00659
US

IV. Provider business mailing address

PO BOX 144004
ARECIBO PR
00614-4004
US

V. Phone/Fax

Practice location:
  • Phone: 787-278-2119
  • Fax: 787-544-7544
Mailing address:
  • Phone: 787-278-2119
  • Fax: 787-544-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD2129
License Number StatePR

VIII. Authorized Official

Name: MRS. JESSETTE S MELON
Title or Position: DENTIST
Credential:
Phone: 787-278-2119