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General NPI Number Information
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NPI Number | 1215064605
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Entity Type | Organization
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Legal Business Name | PUERTO RICO DENTAL CARE
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | VIA MIRTA 3 DS-1 VILLA FONTANA
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-776-0570
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Fax | 787-776-0570
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Provider Business Mailing Address
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Address Line | PO BOX 8480
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City | SAN JUAN
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State | PR
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Zip | 00910-0480
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Country | US
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Telephone | 787-776-0570
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Fax | 787-776-0570
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. JUAN C ORTIZ DE LA RENTA
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Credential | DDS
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Telephone | 787-776-0570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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