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General NPI Number Information
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NPI Number | 1720219900
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Entity Type | Organization
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Legal Business Name | SERVICIOS DE ENDODONCIA DEL SUR
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | ASHFORD MEDICAL PALZA CALLE ASHFORD#128 SUR SUITE 204
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-866-6406
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Fax |
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Provider Business Mailing Address
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Address Line | ASHFORD MEDICAL PALZA CALLE ASHFORD#128 SUR SUITE 204
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-866-6406
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ARHIMAZDA JIMENEZ BAYONA
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Credential | DDS
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Telephone | 787-866-6406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2315
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License Number State | PR
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