Healthcare Provider Details

I. General information

NPI: 1215585906
Provider Name (Legal Business Name): QUALITY DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON STE 713
SAN JUAN PR
00917-5030
US

IV. Provider business mailing address

735 AVE PONCE DE LEON STE 713
SAN JUAN PR
00917-5030
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-8394
  • Fax:
Mailing address:
  • Phone: 787-765-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ALEJANDRO DIAZ RUBAYO
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-765-8394