Healthcare Provider Details

I. General information

NPI: 1952828782
Provider Name (Legal Business Name): CONDADO ORTHODONTICS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 AVE ASHFORD STE 406
SAN JUAN PR
00907
US

IV. Provider business mailing address

100 CALLE DEL MUELLE APT 2204
SAN JUAN PR
00901-2641
US

V. Phone/Fax

Practice location:
  • Phone: 787-415-2868
  • Fax: 787-415-2868
Mailing address:
  • Phone: 787-415-2868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3156
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE A MORALES
Title or Position: OWNER
Credential: DMD
Phone: 787-523-6949