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General NPI Number Information
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NPI Number | 1598188963
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL SERVICES PSC
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | AA10 AVE SANTA JUANITA
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City | BAYAMON
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State | PR
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Zip | 00956-4644
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Country | US
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Telephone | 787-787-5595
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Fax | 787-787-5016
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Provider Business Mailing Address
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Address Line | AA10 AVE SANTA JUANITA
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City | BAYAMON
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State | PR
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Zip | 00956-4644
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Country | US
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Telephone | 787-787-5595
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Fax | 787-787-5016
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DALMA E TORRES
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Credential | DMD
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Telephone | 787-787-5595
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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 | 2761
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License Number State | PR
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