=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063435519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEDRO J ANDUJAR DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | LA FUENTE TOWN CENTER 706 CALLE MARGINAL STE.#11136
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-864-2857
-----------------------------------------------------
Fax | 787-866-4315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | GUARAGUAO #231 SABANERA DEL RIO
-----------------------------------------------------
City | GURABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-744-0680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 1678
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------