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General NPI Number Information
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NPI Number | 1932513835
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Entity Type | Organization
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Legal Business Name | G.A. ORTHODONTICS PSC
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | HC 1 BOX 7271 SUITE 205
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City | HATILLO
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State | PR
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Zip | 00659-7335
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Country | US
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Telephone | 787-880-0365
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Fax |
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Provider Business Mailing Address
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Address Line | HC 1 BOX 7271 SUITE 205
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City | HATILLO
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State | PR
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Zip | 00659-7335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. GAMALIER AYALA
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Credential | DMD, MSD
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Telephone | 787-880-0365
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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 | 2500
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License Number State | PR
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