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General NPI Number Information
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NPI Number | 1255816385
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL SERVICE
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | CARR 110 INT PR 125 MOCA MEDICAL PLAZA 211
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City | MOCA
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State | PR
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Zip | 00676
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Country | US
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Telephone | 787-877-7000
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Fax | 787-877-0115
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Provider Business Mailing Address
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Address Line | PO BOX 1144
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City | MOCA
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State | PR
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Zip | 00676-1144
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Country | US
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Telephone | 787-877-7000
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Fax | 787-877-0115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICARDO J ABRAMS
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Credential | DMD
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Telephone | 787-877-7000
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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 |
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License Number State |
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