Healthcare Provider Details

I. General information

NPI: 1841876471
Provider Name (Legal Business Name): GIAN DANIEL LOURIDO MARTINEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 F D ROOSEVELT AVE SUITE 704 PLAZA LAS AMERICAS TOWER
SAN JUAN PR
00918
US

IV. Provider business mailing address

GC28 CALLE 418
CAROLINA PR
00982-1932
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7967
  • Fax:
Mailing address:
  • Phone: 939-539-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3432
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: