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General NPI Number Information
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NPI Number | 1063925758
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Entity Type | Organization
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Legal Business Name | ASHFORD PERIODONTICS AND IMPLANTS PSC
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 29 CALLE WASHINGTON STE 709
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City | SAN JUAN
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State | PR
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Zip | 00907-1503
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Country | US
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Telephone | 787-400-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CALLE DEL MUELLE CAPITOLIO PLAZA APT 2204
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City | SAN JUAN
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State | PR
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Zip | 00901
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Country | US
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Telephone | 787-403-6228
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. MARIA VICTORIA DIAZ
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Credential | DMD
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Telephone | 787-403-6228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 003156
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License Number State | PR
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