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General NPI Number Information
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NPI Number | 1588518336
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Entity Type | Organization
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Legal Business Name | SRC DENTAL
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Dates
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Enumeration Date | 02/26/2026
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | PLAZA DEL CARMEN MALL #24, 172 AV. PINO
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-745-6220
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Fax |
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Provider Business Mailing Address
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Address Line | 15 CALLE MARSEILLES, CONDOMINIO LE RIVAGE, APT 7E
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 210-838-8746
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOFIA ISABEL RODRIGUEZ
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Credential | DMD
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Telephone | 210-838-8746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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