Healthcare Provider Details

I. General information

NPI: 1538123690
Provider Name (Legal Business Name): ARNALDO JUAN DE JESUS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 CALLE PARANA EL CEREZAL
SAN JUAN PR
00926-3144
US

IV. Provider business mailing address

1692 CALLE PARANA EL CEREZAL
SAN JUAN PR
00926-3144
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-1593
  • Fax: 787-764-9271
Mailing address:
  • Phone: 787-751-1593
  • Fax: 787-764-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number398
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: