Healthcare Provider Details

I. General information

NPI: 1720939457
Provider Name (Legal Business Name): ROSARIO-COLON PEDIATRIC DENTAL PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CALLE JOSE OLIVER APT 906
SAN JUAN PR
00918-2982
US

IV. Provider business mailing address

PO BOX 427
CEIBA PR
00735-0427
US

V. Phone/Fax

Practice location:
  • Phone: 787-909-3306
  • Fax:
Mailing address:
  • Phone: 787-909-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PAOLA MICHELLE ROSARIO COLON
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-909-3306