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General NPI Number Information
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NPI Number | 1295276004
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Entity Type | Organization
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Legal Business Name | MERILE WCC DENTAL SERVICES
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | DC8 AVE MINILLAS STA JUANITA
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-780-8176
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6984
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City | BAYAMON
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State | PR
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Zip | 00960-5984
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Country | US
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Telephone | 787-780-8176
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WANDA CRUZADO
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Credential |
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Telephone | 787-780-8176
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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 | 2280
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License Number State | PR
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