Healthcare Provider Details

I. General information

NPI: 1518636935
Provider Name (Legal Business Name): S&W HEALTHY SMILES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 07/21/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MUOZ RIVERA NO16
JUNCOS PR
00777
US

IV. Provider business mailing address

PO BOX 518 , JUNCOS ,PR 00777
JUNCOS PR
00777
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-5158
  • Fax:
Mailing address:
  • Phone: 787-235-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: WILMA PAGAN
Title or Position: PRESIDENT
Credential:
Phone: 939-400-1387