Healthcare Provider Details

I. General information

NPI: 1700949013
Provider Name (Legal Business Name): ODONTOLOGIA GENERAL Y PEDIATRICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINICA LAS AMERICAS 400 ROOSEVELT AVE SUITE 505
SAN JUAN PR
00918
US

IV. Provider business mailing address

CLINICA LAS AMERICAS 400 ROOSEVELT AVE SUITE 505
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-250-5055
  • Fax: 787-250-0511
Mailing address:
  • Phone: 787-250-5055
  • Fax: 787-250-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS LIONEL MARTINEZ
Title or Position: DUENO
Credential: DDS
Phone: 787-250-5055