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General NPI Number Information
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NPI Number | 1245691740
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Entity Type | Organization
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Legal Business Name | DENTAL CARE CENTER LLC
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | OFICINA 211 TORRE SAN CRISTOBAL,
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City | PONCE
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State | PR
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Zip | 00780
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Country | US
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Telephone | 787-675-4596
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Fax |
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Provider Business Mailing Address
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Address Line | EL SENORIAL PLZ # 1326 CALLE SALUD SUITE 107
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City | PONCE
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State | PR
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Zip | 00717-1686
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Country | US
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Telephone | 787-675-4596
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JUAN C MARRERO GRATACOS
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Credential | MD
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Telephone | 787-675-4596
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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 | D12868-8
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License Number State | PR
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