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General NPI Number Information
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NPI Number | 1477953784
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Entity Type | Organization
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Legal Business Name | HEALTH DENTAL CLINIC
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 77 CALLE CENTRAL
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City | COTO LAUREL
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State | PR
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Zip | 00780-2109
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Country | US
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Telephone | 787-601-7626
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 922
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City | JUANA DIAZ
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State | PR
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Zip | 00795-0922
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Country | US
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Telephone | 787-601-7626
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JUANCARLOS J ROSARIO
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Credential |
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Telephone | 787-601-7626
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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 | D1840
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License Number State | PR
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