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General NPI Number Information
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NPI Number | 1881781516
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Entity Type | Organization
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Legal Business Name | CENTRO DENTAL PEDIATRICO
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | GENERAL VALERO AVENUE 311
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-860-4088
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Fax | 787-863-2441
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Provider Business Mailing Address
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Address Line | PO BOX 1144
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City | FAJURDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-860-4088
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Fax | 787-863-2441
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Authorized Official
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Title or Position | PEDIATRIC DOCTOR
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Name | MARIEDALI SANTIAGO TORRES
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Credential | DMD
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Telephone | 787-860-4088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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