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General NPI Number Information
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NPI Number | 1154510535
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Entity Type | Organization
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Legal Business Name | CARIBBEAN DENTAL CLINIC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 456 CALLE TNTE CESAR GONZALEZ
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City | SAN JUAN
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State | PR
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Zip | 00918-2628
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Country | US
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Telephone | 787-753-2376
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Fax | 787-767-8392
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Provider Business Mailing Address
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Address Line | 200 AVE RAFAEL CORDERO PMB 471 SUITE 140
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City | CAGUAS
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State | PR
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Zip | 00725-3757
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Country | US
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Telephone | 787-753-2376
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Fax | 787-767-8392
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ROSA M RODRIGUEZ
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Credential | DMD
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Telephone | 787-753-2376
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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 | 1839
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1839
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License Number State | PR
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