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General NPI Number Information
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NPI Number | 1710273966
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Entity Type | Organization
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Legal Business Name | EJ DENTAL P.S.C.
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | AVE LAUREL 3R40 LOMAS VERDES
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-798-9424
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Fax |
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Provider Business Mailing Address
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Address Line | AVE LAUREL 3R40 LOMAS VERDES
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone |
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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. ELSA JUSTINIANO
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Credential | DMD
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Telephone | 787-798-9424
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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 |
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License Number State |
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