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General NPI Number Information
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NPI Number | 1225371693
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL SMILES P.S.C
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 610 AVE. COMERIO SUERMERCADOS ECONO LEVITTOWN
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City | LEVITTOWN
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-795-2048
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Fax | 787-261-6677
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Provider Business Mailing Address
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Address Line | PO BOX 50712
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City | TOA BAJA
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State | PR
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Zip | 00950-0712
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Country | US
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Telephone | 787-795-2048
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Fax | 787-261-6677
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAVIER GALLARDO
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Credential | D.M.D
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Telephone | 787-460-5667
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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 | 2529
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License Number State | PR
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