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General NPI Number Information
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NPI Number | 1689819260
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Entity Type | Organization
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Legal Business Name | DIETRICH DENTAL P.S.C
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | LA GALERIA SUCHVILLE 97 CARR 2 STE 208
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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 | 787-705-5063
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Fax | 787-705-5065
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Provider Business Mailing Address
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Address Line | LA GALERIA SUCHVILLE 97 CARR. 2 SUITE 208
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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 | 787-705-5063
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Fax | 787-705-5065
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RENE DIETRICH-TRIGO
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Credential | DMD
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Telephone | 787-705-5063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2179
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License Number State | PR
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