Healthcare Provider Details

I. General information

NPI: 1497259147
Provider Name (Legal Business Name): NATALIA ESTEFANIA LLAURADOR CARABALLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 BLVD LUIS A FERRE STE 202
PONCE PR
00717-2115
US

IV. Provider business mailing address

2431 BLVD LUIS A FERRE STE 202
PONCE PR
00717-2115
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-0080
  • Fax:
Mailing address:
  • Phone: 787-840-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3300
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: