Healthcare Provider Details

I. General information

NPI: 1417968769
Provider Name (Legal Business Name): CENTRO REHABILITACION ORAL E IMPLANTES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A1 CALLE SANTA ROSA URB. ROMANY GARDENS
SAN JUAN PR
00926-5652
US

IV. Provider business mailing address

PO BOX 364623
SAN JUAN PR
00936-4623
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-8620
  • Fax: 787-720-8570
Mailing address:
  • Phone: 787-720-8620
  • Fax: 787-720-8570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1213
License Number StatePR

VIII. Authorized Official

Name: DR. RAMON D. FERRAN
Title or Position: OWNER
Credential: D.M.D.
Phone: 787-720-8620