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General NPI Number Information
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NPI Number | 1710166186
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Entity Type | Organization
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Legal Business Name | BAIROA DENTAL CARE
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | #1511 AVE, PONCE DE LEON, AREA COMERCIAL 4B, TORRE 600 CLUSSWL
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City | SAN JUAN
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State | PR
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Zip | 00909
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Country | US
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Telephone | 787-766-7472
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Fax |
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Provider Business Mailing Address
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Address Line | #1511 AVE, PONCE DE LEON, AREA COMERCIAL 4B, TORRE 600 CIUDADELA
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City | SAN JUAN
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State | PR
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Zip | 00909
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Country | US
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Telephone | 787-766-7472
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ELISA MARI RIVERA
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Credential | DMD
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Telephone | 787-746-6660
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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 | 4638
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License Number State | PR
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