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General NPI Number Information
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NPI Number | 1093637928
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL PR LLC
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 1065 AVE LOS CORAZONES STE 204
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City | MAYAGUEZ
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State | PR
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Zip | 00680-7064
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Country | US
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Telephone | 787-208-9332
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Fax |
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Provider Business Mailing Address
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Address Line | 1065 AVE LOS CORAZONES STE 204
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City | MAYAGUEZ
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State | PR
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Zip | 00680-7064
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Country | US
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Telephone | 787-208-9332
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. GRISEL MARTIR MORENO
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Credential |
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Telephone | 787-833-5917
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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 |
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License Number State |
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