Healthcare Provider Details

I. General information

NPI: 1659698108
Provider Name (Legal Business Name): AMANECER DENTAL CLINIC AND LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA DE DIEGO 467 RIO PIEDRAS
SAN JUAN PR
00923
US

IV. Provider business mailing address

AVENIDA DE DIEGO 467 RIO PIEDRAS
SAN JUAN PR
00923
US

V. Phone/Fax

Practice location:
  • Phone: 787-585-5569
  • Fax:
Mailing address:
  • Phone: 787-585-5569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number StatePR

VIII. Authorized Official

Name: EDWIN ERIC SUAREZ
Title or Position: TECNICO DENTAL
Credential:
Phone: 787-562-9277