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General NPI Number Information
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NPI Number | 1649642117
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Entity Type | Organization
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Legal Business Name | CLINICA DENTAL PLAZA, PSC
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | CAROLINA SHOPP CTR SUITE #30
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City | CAROLINA
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State | PR
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Zip | 00985-5672
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Country | US
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Telephone | 787-752-5700
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Fax | 844-507-0291
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Provider Business Mailing Address
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Address Line | PO BOX 8761
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City | CAROLINA
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State | PR
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Zip | 00988-8761
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Country | US
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Telephone | 787-752-5700
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Fax | 844-507-0291
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FERNANDO L SOSA PADRO
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Credential | D.M.D.
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Telephone | 787-645-8552
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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 | 1333
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License Number State | PR
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