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General NPI Number Information
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NPI Number | 1093843765
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Entity Type | Individual
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Provider Name | GUILLERMO ROCAFORT ORTEGA DDS
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | LIZZIE GRAHAM JR3 LEVITOUN
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City | BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-789-1627
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Fax | 787-789-1627
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Provider Business Mailing Address
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Address Line | PO BOX 367064 136 ZOMESE RIO PIEDES HEIGHTS
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City | SAN JUAN
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State | PR
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Zip | 00936
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Country | US
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Telephone | 787-525-6999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2172
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License Number State | PR
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