Healthcare Provider Details

I. General information

NPI: 1043308125
Provider Name (Legal Business Name): CARLOS J BUSQUETS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 FERNANDO MONTILLA
SAN JUAN PR
00918
US

IV. Provider business mailing address

397 FERNANDO MONTILLA
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-8515
  • Fax: 787-766-0939
Mailing address:
  • Phone: 787-758-8515
  • Fax: 787-766-0939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number868
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: