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General NPI Number Information
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NPI Number | 1508286048
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Entity Type | Organization
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Legal Business Name | SMILE 4 KIDS, PEDIATRIC DENTISTRY, CSP
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 1 AVE ARBOLOTE PLAZA REAL SHOPPING CENTER, SUITE 205
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City | GUAYNABO
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State | PR
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Zip | 00969-2806
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Country | US
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Telephone | 787-567-5437
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Fax | 787-999-0137
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Provider Business Mailing Address
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Address Line | 35 CALLE JUAN C BORBON STE 67 PMB 384
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City | GUAYNABO
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State | PR
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Zip | 00969-5375
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Country | US
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Telephone | 787-567-5437
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Fax | 787-999-0137
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HILDA M MENDEZ
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Credential | DMD
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Telephone | 787-567-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2279
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2057
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License Number State | PR
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