Healthcare Provider Details

I. General information

NPI: 1053099861
Provider Name (Legal Business Name): TOA ALTA DENTAL INSTITUTED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIO DEL PLATA MALL CARR 165 ESQ CALLE 1
TOA ALTA PR
00953
US

IV. Provider business mailing address

1353 LUIS VIGOREAUX PMB 223
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-513-1132
  • Fax:
Mailing address:
  • Phone: 787-513-1132
  • 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. JOSE FRANCISCO CASTILLO
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-513-1132