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General NPI Number Information
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NPI Number | 1427432491
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Entity Type | Organization
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Legal Business Name | GUAYNABO ORTHODONTICS C.P.
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Dates
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Enumeration Date | 07/19/2015
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Last Update Date | 07/19/2015
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Provider Practice Location Address
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Address Line | 57 AVE ESMERALDA URB MUNOZ RIVERA
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City | GUAYNABO
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State | PR
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Zip | 00969-4429
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Country | US
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Telephone | 787-720-0820
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Fax | 787-720-1409
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Provider Business Mailing Address
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Address Line | 57 AVE ESMERALDA URB MUNOZ RIVERA
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City | GUAYNABO
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State | PR
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Zip | 00969-4429
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Country | US
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Telephone | 787-720-0820
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Fax | 787-720-1409
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Authorized Official
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Title or Position | ORTHODONTIST/PRESIDENT
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Name | DR. CARLOS A MENDEZ-VILLAMIL
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Credential |
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Telephone | 787-720-0820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1203
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License Number State | PR
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