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General NPI Number Information
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NPI Number | 1679618011
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Entity Type | Organization
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Legal Business Name | IBG PSC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | SUITE 202A, 107 AVE. GONZALEZ GUISTI
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City | GUAYNABO
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State | PR
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Zip | 00966
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Country | US
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Telephone | 787-707-1977
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CALLE J VILLA CAPARRA
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City | GUAYNABO
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State | PR
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Zip | 00966-2203
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Country | US
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Telephone | 787-397-3644
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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. IRENE BANUCHI
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Credential | D.M.D.
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Telephone | 787-707-1977
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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 | PR1927
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License Number State | PR
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