Healthcare Provider Details

I. General information

NPI: 1730184128
Provider Name (Legal Business Name): ROBERTO EMILIO BACO VIAMONTE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 PASEO LAS MONJITAS
PONCE PR
00730-3901
US

IV. Provider business mailing address

1249 PASEO LAS MONJITAS
PONCE PR
00730-3901
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-5378
  • Fax: 787-842-9174
Mailing address:
  • Phone: 787-841-5378
  • Fax: 787-842-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1900
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: