Healthcare Provider Details

I. General information

NPI: 1346025665
Provider Name (Legal Business Name): DENTAL PEDIATRICS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 BDA FELIX SECT CORDOVA DAVILA
MANATI PR
00674
US

IV. Provider business mailing address

URB LAS CUMBRES II CALLE BAYAMON #484
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-7429
  • Fax:
Mailing address:
  • Phone: 939-404-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISHA C SOTO GONZALEZ
Title or Position: DENTIST
Credential: DMD
Phone: 787-854-7429