Healthcare Provider Details

I. General information

NPI: 1851401145
Provider Name (Legal Business Name): ALOYSIO GRIBEL JUNQUEIRA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SON GERMAN MEDICAL PLAZA CARR 2 KM 174 SUITE 201
SAN GERMAN PR
00683-0188
US

IV. Provider business mailing address

PO BOX 188
SAN GERMAN PR
00683-0188
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-1010
  • Fax: 787-892-1011
Mailing address:
  • Phone: 787-892-1010
  • Fax: 787-892-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2616
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: