=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588535173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EL SENOR DE LOS DIENTES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 152 KM 7.6 BO QUEBRADILLAS SEC LOS LOPEZ
-----------------------------------------------------
City | BARRANQUITAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-370-4346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 71 BOX 3278
-----------------------------------------------------
City | NARANJITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00719-9536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. OMAR RIVERA LOPEZ
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 787-370-4346
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------