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General NPI Number Information
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NPI Number | 1124102751
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Entity Type | Individual
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Provider Name | JULIO DEMETRIO GOYCO D.M.D
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2120 AVE LAS AMERICAS VILLA GRILLASCA
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City | PONCE
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State | PR
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Zip | 00717-0722
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Country | US
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Telephone | 787-843-5526
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Fax |
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Provider Business Mailing Address
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Address Line | 1757 CALLE SERENATA URB. MERCEDITA
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City | PONCE
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State | PR
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Zip | 00717-2608
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Country | US
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Telephone | 787-843-2824
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1055
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License Number State | PR
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