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General NPI Number Information
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NPI Number | 1265597363
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Entity Type | Individual
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Provider Name | THOMAS MANUEL MEDINA D.D.S., G.P.R.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | ANTONIO R. BARCELO AVE SIERRA DE CAYEY SUITE 202
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City | CAYEY
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State | PR
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Zip | 00736
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Country | US
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Telephone | 787-263-4777
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Fax |
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Provider Business Mailing Address
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Address Line | ANTONIO R. BARCELO AVE SIERRA DE CAYEY SUITE 202
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City | CAYEY
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State | PR
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Zip | 00736
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Country | US
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Telephone | 787-263-4777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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