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General NPI Number Information
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NPI Number | 1104977115
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Entity Type | Organization
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Legal Business Name | ESCUELA DE ODONTOLOGIA
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | AVE. AMERICO MIRANDA CENTOR MEDICO
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City | RIO PIEDRAS
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-758-2525
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Fax | 787-766-0757
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Provider Business Mailing Address
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Address Line | PO BOX 365067
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City | SAN JUAN
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State | PR
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Zip | 00936-5067
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Country | US
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Telephone | 787-758-2525
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Fax | 787-766-0757
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Authorized Official
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Title or Position | ASSISTANT DEAN CLINICAL AFFAIRS
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Name | DR. HECTOR LUIS QUESADA
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Credential | DMD
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Telephone | 787-758-2525
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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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