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General NPI Number Information
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NPI Number | 1679951701
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Entity Type | Organization
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Legal Business Name | ROSALEDA DENTAL CARE,PSC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | AL4 AVE FIDALGO DIAZ VILLA FONTANA
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City | CAROLINA
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State | PR
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Zip | 00983-0983
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Country | US
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Telephone | 787-701-2613
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Fax | 787-701-2613
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Provider Business Mailing Address
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Address Line | 350 VIA AVENTURA APT#6602 ENCANTADA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-6184
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Country | US
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Telephone | 787-701-2613
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Fax | 787-701-2613
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JEANETTE CABRERA
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Credential | D.M.D.
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Telephone | 787-701-2613
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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 | 2392
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License Number State | PR
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