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General NPI Number Information
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NPI Number | 1235284480
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Entity Type | Organization
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Legal Business Name | SERVICIOS DE SALUD ORAL, CSP
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1225 CALLE MARGINAL VILLAMAR
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 787-727-8960
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Fax | 787-726-0802
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Provider Business Mailing Address
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Address Line | 1225 CALLE MARGINAL VILLAMAR
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 178-772-7896
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Fax | 178-772-6080
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Authorized Official
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Title or Position | CORPORATION'S PRESIDENT
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Name | DR. MILITZA FERNANDEZ RIOS
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Credential | D.M.D.
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Telephone | 17877278960
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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 | 891
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License Number State | PR
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