Healthcare Provider Details

I. General information

NPI: 1104052455
Provider Name (Legal Business Name): ESCUELA DE MEDICINA DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 AVE BARBOSA
SANTURCE PR
00915-3203
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: 787-728-4190
  • Fax: 787-728-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2389
License Number StatePR

VIII. Authorized Official

Name: DR. LINDANYR ARROYO
Title or Position: GENERAL DENTIST
Credential: D.M.D
Phone: 787-728-4190