Healthcare Provider Details

I. General information

NPI: 1912810557
Provider Name (Legal Business Name): LOURIDO PERIODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE F. D. ROOSEVELT SUITE 704 PLAZA LAS AMERICAS TOWER
SAN JUAN PR
00918
US

IV. Provider business mailing address

GC28 CALLE 418
CAROLINA PR
00982-1932
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7967
  • Fax:
Mailing address:
  • Phone: 939-539-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GIAN DANIEL LOURIDO MARTINEZ
Title or Position: PRESIDENT - PERIODONTIST
Credential: DMD, MSD
Phone: 939-539-0849