Healthcare Provider Details

I. General information

NPI: 1104977115
Provider Name (Legal Business Name): ESCUELA DE ODONTOLOGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. AMERICO MIRANDA CENTOR MEDICO
RIO PIEDRAS PR
00926
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-766-0757
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-766-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HECTOR LUIS QUESADA
Title or Position: ASSISTANT DEAN CLINICAL AFFAIRS
Credential: DMD
Phone: 787-758-2525