Healthcare Provider Details

I. General information

NPI: 1487847943
Provider Name (Legal Business Name): CUIDADO DENTAL TERAPEUTICO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2007
Last Update Date: 08/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CALLE TOUS SOTO URB. BALDRICH
SAN JUAN PR
00918-4312
US

IV. Provider business mailing address

215 CALLE TOUS SOTO URB. BALDRICH
SAN JUAN PR
00918-4312
US

V. Phone/Fax

Practice location:
  • Phone: 787-316-7091
  • Fax:
Mailing address:
  • Phone: 787-316-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1895
License Number StatePR

VIII. Authorized Official

Name: CARLOS A LOPEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-316-7091