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General NPI Number Information
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NPI Number | 1508675372
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Entity Type | Organization
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Legal Business Name | COROZAL DENTAL OFFICE
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | CARRETERA 891 KM 15.1
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City | COROZAL
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State | PR
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Zip | 00783-9404
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Country | US
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Telephone | 787-859-0070
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Fax |
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Provider Business Mailing Address
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Address Line | HC 01 BOX 3021
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City | COROZAL
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State | PR
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Zip | 00783-9404
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Country | US
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Telephone | 787-859-0070
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MR. ERNESTO J PEREZ SR.
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Credential | DMD
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Telephone | 787-859-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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