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General NPI Number Information
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NPI Number | 1376361824
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Entity Type | Organization
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Legal Business Name | GC PERIODONTICS LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | INSTITUTO SAN PABLO CALLE SANTA CRUZ #66 SUITE 103
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City | BAYAMON
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State | PR
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Zip | 00961
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Country | US
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Telephone | 787-925-1665
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 AVE PONCE DE LEON TORRE 900 APT. 994
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City | SAN JUAN
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State | PR
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Zip | 00909
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Country | US
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Telephone | 787-371-0209
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GABRIELLA CORDERO GALLARDO
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Credential | DMD
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Telephone | 787-422-6861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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