=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821515511
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL WORLD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2017
-----------------------------------------------------
Last Update Date | 08/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 654 AVE SAN PATRICIO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00920-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-792-6266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AN 65 PLAZA SAN THOMAS ANTILLANA
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-792-6266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ELISA M RIVERA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 787-361-0015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2736
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------