Healthcare Provider Details

I. General information

NPI: 1871640003
Provider Name (Legal Business Name): RUBEN O COLON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 CALLE LODI VILLA CAPRI
SAN JUAN PR
00924-3842
US

IV. Provider business mailing address

603 CALLE LODI VILLA CAPRI
SAN JUAN PR
00924-3842
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-0704
  • Fax: 787-765-0704
Mailing address:
  • Phone: 787-765-0704
  • Fax: 787-765-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1283
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: