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General NPI Number Information
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NPI Number | 1720235674
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Entity Type | Individual
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Provider Name | NICOLE MARIE MALDONADO DMD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 390 CALLE SAN CLAUDIO URB SAGRADO CORAZON
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City | SAN JUAN
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State | PR
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Zip | 00926-4107
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Country | US
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Telephone | 787-748-2025
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Fax | 787-760-2785
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Provider Business Mailing Address
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Address Line | #756 CAMPOS MONTEHIEDRA
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-447-0575
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Fax | 787-760-2785
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2821
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License Number State | PR
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