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General NPI Number Information
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NPI Number | 1770731259
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Entity Type | Organization
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Legal Business Name | SONRISAS HERMOSAS, CSP
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | CALLE MARGINAL ROAD 1 KM. 16.1
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City | BAYAMON
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State | PR
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Zip | 00957-2536
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Country | US
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Telephone | 787-756-6125
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Fax | 787-756-6125
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Provider Business Mailing Address
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Address Line | PO BOX 1527
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City | TRUJILLO ALTO
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State | PR
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Zip | 00977-1527
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Country | US
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Telephone | 787-756-6125
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Fax | 787-756-6125
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELAINE M. PAGAN
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Credential | DMD
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Telephone | 787-756-6125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 1865
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License Number State | PR
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