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General NPI Number Information
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NPI Number | 1730549106
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Entity Type | Organization
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Legal Business Name | QUALITY ENDODONTICS PSC
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 89-1 CALLE 99 AVENIDA ROBERTO CLEMENTE
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-757-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CONDOMINIO CORAL BEACH APT 910
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 787-553-2738
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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. RICKY GONZALEZ
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Credential | DMD
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Telephone | 787-553-2738
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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 | 3175
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License Number State | PR
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