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General NPI Number Information
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NPI Number | 1790244119
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Entity Type | Organization
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Legal Business Name | FAMILY PRO SMILES
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | EDIFICIO COLON PLAZA CARR 110 KM 12.4
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City | MOCA
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State | PR
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Zip | 00676-0000
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Country | US
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Telephone | 787-877-2500
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Fax | 787-877-2505
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Provider Business Mailing Address
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Address Line | PO BOX 400
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City | MOCA
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State | PR
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Zip | 00676-0400
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Country | US
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Telephone | 787-877-2500
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Fax | 787-877-2505
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLOS M NIEVES MENDEZ
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Credential | DMD
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Telephone | 787-877-2500
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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 |
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License Number State |
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