Healthcare Provider Details

I. General information

NPI: 1346434123
Provider Name (Legal Business Name): ALAMEDA PROSTHODONTIC SERVICES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CALLE DR NELSON PEREA EDIF. DOCTOR CENTER, SUITE 201
MAYAGUEZ PR
00680-4949
US

IV. Provider business mailing address

27 CALLE DR NELSON PEREA EDIF. DOCTOR CENTER, SUITE 201
MAYAGUEZ PR
00680-4949
US

V. Phone/Fax

Practice location:
  • Phone: 787-466-4883
  • Fax:
Mailing address:
  • Phone: 787-466-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2650
License Number StatePR

VIII. Authorized Official

Name: DR. MARVIN ALAMEDA
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-466-4883