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General NPI Number Information
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NPI Number | 1437301140
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Entity Type | Organization
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Legal Business Name | WESTERN COSMETIC ORAL AND MAXILLOFACIAL SURGERY CLINIC
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 27 NELSON PEREA ST. DOCTORS CENTER BLDNG. SUITE 206
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City | MAYAGUEZ
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State | P.R.
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Zip | 00680
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Country | UM
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Telephone | 787-833-1215
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Fax | 787-265-0589
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Provider Business Mailing Address
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Address Line | APARTADO 37
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City | MAYAGUEZ
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State | P.R.
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Zip | 00681
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Country | UM
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Telephone | 787-833-1215
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Fax | 787-265-0589
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OSCAR MUNIZ LUCIANO
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Credential | M.D., D.M.D.
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Telephone | 787-833-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2147
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License Number State | PR
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