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General NPI Number Information
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NPI Number | 1407025612
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Entity Type | Organization
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Legal Business Name | SM DENTAL PSC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | CALLE IGNACIO ARZUAGA 5W CAROLINA PUEBLO
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-769-6880
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Fax | 787-776-0757
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Provider Business Mailing Address
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Address Line | PO BOX 871 PUEBLO STATION
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City | CAROLINA
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State | PR
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Zip | 00986
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Country | US
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Telephone | 787-769-6880
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Fax | 787-776-0757
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MIRIAM E MELENDEZ
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Credential |
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Telephone | 787-769-6880
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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 | 1333
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License Number State | PR
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