Healthcare Provider Details

I. General information

NPI: 1336575349
Provider Name (Legal Business Name): DUARTE DENTAL CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 CALLE DUARTE SUITE 5B
SAN JUAN PR
00917-3631
US

IV. Provider business mailing address

229 CALLE DUARTE SUITE 5B
SAN JUAN PR
00917-3631
US

V. Phone/Fax

Practice location:
  • Phone: 787-630-8288
  • Fax: 787-651-6683
Mailing address:
  • Phone: 787-630-8288
  • Fax: 787-651-6683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2868
License Number StatePR

VIII. Authorized Official

Name: DR. DIAZ RODRIGUEZ ERIKA
Title or Position: DOCTOR
Credential: DMD
Phone: 787-487-5332