Healthcare Provider Details

I. General information

NPI: 1003947284
Provider Name (Legal Business Name): SONRISAS RADIANTES DENTAL CLINIC(CSP)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO GRAN CARIBE SUITE 209
VEGA ALTA PR
00692-6711
US

IV. Provider business mailing address

CENTRO GRAN CARIBE SUITE 214
VEGA ALTA PR
00692-6711
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-6446
  • Fax: 787-883-6058
Mailing address:
  • Phone: 787-883-6446
  • Fax: 787-883-6058

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: MAGALY MARRERO
Title or Position: OFFICE MANAGER
Credential:
Phone: 787-883-6446