Healthcare Provider Details

I. General information

NPI: 1750415402
Provider Name (Legal Business Name): ALL ORTHODONTICS SERVICES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 AVE AMERICO MIRANDA
SAN JUAN PR
00921-2118
US

IV. Provider business mailing address

1311 AVE AMERICO MIRANDA
SAN JUAN PR
00921-2118
US

V. Phone/Fax

Practice location:
  • Phone: 787-792-2850
  • Fax: 787-749-0406
Mailing address:
  • Phone: 787-792-2850
  • Fax: 787-749-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1520
License Number StatePR

VIII. Authorized Official

Name: DAVID SANTIAGO
Title or Position: PRESIDENT
Credential:
Phone: 787-792-2850