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General NPI Number Information
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NPI Number | 1710303755
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Entity Type | Organization
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Legal Business Name | L .R. DENTAL C.S.P.
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 1270 CALLE 54 SE URB LA RIVIERA
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City | SAN JUAN
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State | PR
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Zip | 00921
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Country | US
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Telephone | 787-783-1259
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 CALLE 54 SE URB LA RIVIERA
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City | SAN JUAN
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State | PR
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Zip | 00921
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Country | US
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Telephone | 787-783-1259
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JUAN R VIVES PAGAN
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Credential | D.M.D.
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Telephone | 787-783-1259
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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 | D1452
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License Number State | PR
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