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General NPI Number Information
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NPI Number | 1245419068
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Entity Type | Organization
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Legal Business Name | MEDBAR DENTAL SERVICE PSC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | AVE ANTONIO R BARCELO SIERRA DE CAYEY SUITE 202
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City | CAYEY
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State | PR
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Zip | 00736-3717
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Country | US
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Telephone | 787-263-4777
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Fax | 787-738-0231
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Provider Business Mailing Address
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Address Line | AVE ANTONIO R BARCELO SIERRA DE CAYEY SUITE 202
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City | CAYEY
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State | PR
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Zip | 00736-3717
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Country | US
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Telephone | 787-263-4777
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Fax | 787-738-0231
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS MANUEL MEDINA
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Credential | DDS
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Telephone | 787-263-4777
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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 | 1938
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License Number State | PR
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