=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801770573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FG ENDO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2025
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 AVE FD ROOSEVELT STE 506
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-2163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-250-0907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 366949
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-6949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-378-0622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEAN PAUL FRAME GONZALEZ
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 787-378-0622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------