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General NPI Number Information
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NPI Number | 1902304306
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Entity Type | Organization
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Legal Business Name | DML DENTAL SERVICES LLC
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 544 ALDEBARAN STREET, URB. ALTAMIRA EDIF. EDGEWELL, OFIC. 102
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City | SAN JUAN
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State | PR
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Zip | 00920
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Country | US
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Telephone | 787-230-7573
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Fax |
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Provider Business Mailing Address
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Address Line | 544 CALLE ALDEBARAN STE 102
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City | SAN JUAN
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State | PR
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Zip | 00920-4227
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Country | US
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Telephone | 787-230-7573
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DELIAN LOYOLA
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Credential | DMD
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Telephone | 787-230-7573
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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 | 3207
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License Number State | PR
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