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General NPI Number Information
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NPI Number | 1154618163
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Entity Type | Organization
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Legal Business Name | SERVICIOS DENTALES DEL PUEBLO
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | JR 1 LIZZIE GRAHAM MARGINAL TMA SECC LEVITTOWN
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City | TOA BOJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-784-1627
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Fax |
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Provider Business Mailing Address
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Address Line | JR 1 LIZZIE GRAHAM MARGINAL TMA SECC LEVITTOWN
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City | TOA BOJA
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State | PR
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Zip | 00949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTISTA
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Name | GUILLERMO ROCAFORT ORTEGA
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Credential | DDS
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Telephone | 787-784-1627
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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 | 2192
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License Number State | PR
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