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General NPI Number Information
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NPI Number | 1598116311
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Entity Type | Organization
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Legal Business Name | WESTERN DENTAL P.S.C.
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 256 CALLE LA PAZ
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City | AGUADA
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State | PR
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Zip | 00602-2939
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Country | US
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Telephone | 787-868-3190
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Fax |
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Provider Business Mailing Address
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Address Line | HC 5 BOX 15552
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City | MOCA
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State | PR
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Zip | 00676-9649
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Country | US
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Telephone | 787-439-5728
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUAN GILBERTO SANCHEZ
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Credential |
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Telephone | 787-439-5728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3201
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License Number State | PR
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