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General NPI Number Information
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NPI Number | 1689816910
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Entity Type | Organization
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Legal Business Name | SONRISAS DENTAL CARE PSC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | A 2010 AZALEA ST LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-784-1035
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Fax | 787-784-0120
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Provider Business Mailing Address
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Address Line | CALLE AZALEA A 2010 LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-784-1035
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Fax | 787-784-0120
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE A VELAZQUEZ
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Credential | DMD
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Telephone | 787-784-1035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0450
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License Number State | PR
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