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General NPI Number Information
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NPI Number | 1912701376
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Entity Type | Organization
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Legal Business Name | PERIODONCIA DEL OESTE LLC
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | EDIFICIO MEDICOS DE DIEGO 14 E CALLE DE DIEGO
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City | MAYAGUEZ
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State | PR
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Zip | 00680
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Country | US
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Telephone | 787-833-3548
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Fax | 787-265-7788
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Provider Business Mailing Address
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Address Line | PO BOX 2896
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City | MAYAGUEZ
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State | PR
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Zip | 00681-2896
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Country | US
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Telephone | 787-833-3548
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Fax | 787-265-7788
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. ALBERTO IVAN ALMODOVAR
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Credential | DMD
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Telephone | 787-833-3548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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