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General NPI Number Information
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NPI Number | 1265066120
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Entity Type | Organization
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Legal Business Name | ROOTCANALS TO GO PSC
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | VILLA CAPRI 585 CALLE LODI
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-530-7094
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Fax |
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Provider Business Mailing Address
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Address Line | VILLA CAPRI 585 CALLE LODI
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-530-7094
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLARA DE JESUS
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Credential | DS
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Telephone | 787-530-7094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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