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General NPI Number Information
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NPI Number | 1932528163
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Entity Type | Organization
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Legal Business Name | CENTRO PROFESIONAL MEDICO DENTAL,CSP
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 80 CALLE JOSE J ACOSTA
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City | VEGA BAJA
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State | PR
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Zip | 00693-4435
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Country | US
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Telephone | 787-858-1057
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Fax | 787-858-7964
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Provider Business Mailing Address
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Address Line | 443 CAMINO DE GUAJATACA URB SABANERA
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City | DORADO
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State | PR
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Zip | 00646-3637
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Country | US
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Telephone | 787-858-1057
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Fax | 787-858-7964
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Authorized Official
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Title or Position | DENTISTA
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Name | DR. YAIRA ROJAS TORRES
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Credential | DMD
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Telephone | 787-858-1057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 02326
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License Number State | PR
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