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General NPI Number Information
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NPI Number | 1558330753
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Entity Type | Individual
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Provider Name | JOSE MANUEL SERRANO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | BARRIO PITAHAYA CARR 924 KM3.3
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-955-2901
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Fax |
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Provider Business Mailing Address
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Address Line | 163 MANSIONES DE LOS ARTESANOS
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City | LAS PIEDRAS
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State | PR
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Zip | 00771-4694
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Country | US
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Telephone | 787-473-6814
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Fax | 787-473-6814
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14229
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1972
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License Number State | PR
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