Healthcare Provider Details

I. General information

NPI: 1114923653
Provider Name (Legal Business Name): CLARA E DE JESUS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 CALLE NAPOLES STE 203
SAN JUAN PR
00924-4605
US

IV. Provider business mailing address

570 CALLE NAPOLES STE 203
SAN JUAN PR
00924-4605
US

V. Phone/Fax

Practice location:
  • Phone: 787-760-3260
  • Fax: 787-748-5177
Mailing address:
  • Phone: 787-760-3260
  • Fax: 787-748-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1750
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: