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General NPI Number Information
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NPI Number | 1104213099
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Entity Type | Organization
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Legal Business Name | AJL DENTAL
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 607 CALLE DR LOYOLA
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City | PENUELAS
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State | PR
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Zip | 00624
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Country | US
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Telephone | 787-464-4142
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CALLE 25 DE JULIO
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City | GUANICA
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State | PR
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Zip | 00653-2110
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Country | US
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Telephone | 787-464-7980
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHY BRAYFIELD
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Credential |
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Telephone | 787-836-2424
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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 | 1585
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License Number State | PR
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