Healthcare Provider Details

I. General information

NPI: 1629117437
Provider Name (Legal Business Name): PEDRO A. RAMIREZ-RIVERA D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 CALLE LUIS F MACHICOTE 2DA EXT. COUNTRY CLUB
SAN JUAN PR
00924-3423
US

IV. Provider business mailing address

105 AVE ORTEGON PH 2 105 ORTEGON STREET
GUAYNABO PR
00966-2538
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-1105
  • Fax: 787-757-1105
Mailing address:
  • Phone: 787-782-1915
  • Fax: 787-782-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1123
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: