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General NPI Number Information
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NPI Number | 1205207487
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Entity Type | Organization
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Legal Business Name | RG DENTAL PSC
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | A1 AVENIDA AGUSTIN PEREZ ANDINO VILLAS DE RIO GRANDE
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City | RIO GRANDE
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State | PR
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Zip | 00745
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Country | US
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Telephone | 787-887-7907
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Fax | 787-887-4676
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Provider Business Mailing Address
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Address Line | PO BOX 2252
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City | RIO GRANDE
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State | PR
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Zip | 00745-2239
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Country | US
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Telephone | 787-887-4020
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Fax | 787-887-4676
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID SOTO
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Credential |
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Telephone | 787-887-4020
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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 | 1946
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License Number State | PR
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