Healthcare Provider Details

I. General information

NPI: 1295852598
Provider Name (Legal Business Name): ESCUELA DE ODONTOLOGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE BARBOSA 608 CLINICA DENTAL COMUNITARIA CANTERA SUITE 4
SAN JUAN PR
00919-1274
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-4190
  • Fax: 787-728-4190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAMARIS MOLINA
Title or Position: ASSISTAN PROFESSOR
Credential:
Phone: 787-758-2525