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General NPI Number Information
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NPI Number | 1881984854
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Entity Type | Organization
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Legal Business Name | CLINICA DENTAL JIREH
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | R14 COLINA LA MARQUESA URB LAS COLINAS
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City | TOA BAJA
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State | PR
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Zip | 00949-4930
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Country | US
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Telephone | 787-786-4133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1435
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City | SABANA SECA
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State | PR
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Zip | 00952
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Country | UM
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Telephone | 787-786-4133
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOSE BERRIOS
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Credential |
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Telephone | 787-786-4133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2029
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2155
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License Number State | PR
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