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General NPI Number Information
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NPI Number | 1295653194
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Entity Type | Organization
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Legal Business Name | LC ILLUSION DENTAL CLINIC AND LABORATORY CORP
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Dates
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Enumeration Date | 07/08/2026
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Last Update Date | 07/08/2026
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Provider Practice Location Address
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Address Line | CARR. 798 KM 30.0 BARRIO RIO CANAS
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City | CAGUAS, PR
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State | PR
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Zip | 00725-9518
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Country | US
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Telephone | 787-396-8371
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Fax |
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Provider Business Mailing Address
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Address Line | HC 6 BOX 76055
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City | CAGUAS
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State | PR
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Zip | 00725-9504
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Country | US
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Telephone | 787-747-6574
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Fax | 787-747-6574
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Authorized Official
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Title or Position | PR4ESIDENT
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Name | MRS. LORRAINE CANET
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Credential | CANET
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Telephone | 787-747-6574
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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 |
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License Number State |
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