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General NPI Number Information
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NPI Number | 1710593017
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Entity Type | Organization
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Legal Business Name | BOARD CERTIFIED ORTHODONTICS LLC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | URB. VILLA DEL ROSARIO CALLE 2, A3
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City | NAGUABO
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State | PR
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Zip | 00718
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Country | US
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Telephone | 787-460-0283
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Fax |
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Provider Business Mailing Address
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Address Line | URB EL MIRADOR DE CUPEY A6 CALLE 2
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City | SAN JUAN
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State | PR
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Zip | 00926-7545
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Country | US
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Telephone | 787-460-0283
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. NELSON RUIZ-FEBO
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Credential | DMD
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Telephone | 787-460-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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