Healthcare Provider Details

I. General information

NPI: 1881671824
Provider Name (Legal Business Name): SILVANA MARIBEL PONS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CALLE MARGINAL URB MONTE CARLO
VEGA BAJA PR
00693-4239
US

IV. Provider business mailing address

PO BOX 4223
VEGA BAJA PR
00694-4223
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-6776
  • Fax: 787-855-6776
Mailing address:
  • Phone: 787-855-6776
  • Fax: 787-855-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2398
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: