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General NPI Number Information
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NPI Number | 1407239122
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Entity Type | Organization
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Legal Business Name | COSEDEN,INC.
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | ZA14 AVE COMERIO RIVERVIEW
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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 | 787-459-3925
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 439
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City | SABANA SECA
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State | PR
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Zip | 00952-0439
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Country | US
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Telephone | 787-459-3925
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Fax |
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Authorized Official
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Title or Position | REGENT OFICIAL
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Name | DR. JAIME A PEDRAZA
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Credential | D.D.S.
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Telephone | 787-459-3925
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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 | 2063
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License Number State | PR
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