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General NPI Number Information
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NPI Number | 1184342925
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Entity Type | Organization
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Legal Business Name | PERIOIMPLANTPR
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | B8 CALLE SANTA CRUZ
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City | BAYAMON
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State | PR
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Zip | 00961-6902
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Country | US
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Telephone | 787-269-8687
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Fax |
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Provider Business Mailing Address
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Address Line | B8 CALLE SANTA CRUZ
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City | BAYAMON
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State | PR
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Zip | 00961-6902
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Country | US
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Telephone | 787-269-8687
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICARDO JOSEV ALMODOVAR COLON
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Credential | DMD, MS
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Telephone | 787-647-0814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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