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General NPI Number Information
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NPI Number | 1609010339
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC CARE
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | CARR. 189 KM 3.1 BO. RINCON
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City | GURABO
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State | PR
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Zip | 00778
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Country | US
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Telephone | 787-905-7300
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Fax | 787-905-7301
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Provider Business Mailing Address
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Address Line | HC 2 BOX 16216
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City | GURABO
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State | PR
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Zip | 00778-9620
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Country | US
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Telephone | 787-905-7300
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Fax | 787-905-7301
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WILLIAM DIAZ
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Credential |
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Telephone | 787-905-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2100
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License Number State | PR
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