Healthcare Provider Details

I. General information

NPI: 1275658684
Provider Name (Legal Business Name): DORA EMANUELLI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2914 AVE EMILIO FAGOT PONCE
PONCE PR
00716-3611
US

IV. Provider business mailing address

2914 AVE EMILIO FAGOT PONCE
PONCE PR
00716-3611
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-2881
  • Fax: 787-840-7726
Mailing address:
  • Phone: 787-841-2881
  • Fax: 787-840-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1925
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: