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General NPI Number Information
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NPI Number | 1083198576
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Entity Type | Organization
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Legal Business Name | SAN JUAN DENTAL CENTER LLC
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 456 CALLE CESAR GONZALEZ
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City | SAN JUAN
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State | PR
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Zip | 00918-2628
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Country | US
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Telephone | 787-645-0089
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Fax |
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Provider Business Mailing Address
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Address Line | 456 CALLE CESAR GONZALEZ
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City | SAN JUAN
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State | PR
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Zip | 00918-2628
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Country | US
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Telephone | 787-645-0089
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | ROSA MARIA RODRIGUEZ
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Credential | DMD
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Telephone | 787-645-0089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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