Healthcare Provider Details

I. General information

NPI: 1225371693
Provider Name (Legal Business Name): BEAUTIFUL SMILES P.S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 AVE. COMERIO SUERMERCADOS ECONO LEVITTOWN
LEVITTOWN PR
00949
US

IV. Provider business mailing address

PO BOX 50712
TOA BAJA PR
00950-0712
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2048
  • Fax: 787-261-6677
Mailing address:
  • Phone: 787-795-2048
  • Fax: 787-261-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2529
License Number StatePR

VIII. Authorized Official

Name: DR. JAVIER GALLARDO
Title or Position: DENTIST
Credential: D.M.D
Phone: 787-460-5667