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General NPI Number Information
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NPI Number | 1003004714
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Entity Type | Organization
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Legal Business Name | SERVICIOS ESPECIALIZADOS DE ORTODONCIA
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | OFFICE 12 65 INFANTERIA RIO PIEDRAS CENT COM LOS FLAMBOYANES
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City | SAN JUAN
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State | PR
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Zip | 00924-3314
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Country | US
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Telephone | 178-775-8156
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Fax | 178-775-8151
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Provider Business Mailing Address
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Address Line | OFFICE 12 65 INFANTERIA CENT COM LOS FLAMBOYANES
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City | SAN JUAN
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State | PR
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Zip | 00924-3314
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Country | US
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Telephone | 178-775-8156
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Fax | 178-775-8151
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR L ACEVEDO
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Credential | DMD ,MS
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Telephone | 17877581560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 864
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License Number State | PR
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