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General NPI Number Information
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NPI Number | 1942126628
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Entity Type | Organization
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Legal Business Name | NOVA DENTAL LLC
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Dates
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Enumeration Date | 06/26/2026
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | CARR 181 KM 22.9 BO CELADA LOCAL 4 EDIF SOTERO GOMEZ
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City | GURABO
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State | PR
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Zip | 00778
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Country | US
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Telephone | 787-712-8857
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1104
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City | GURABO
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State | PR
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Zip | 00778-1104
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Country | US
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Telephone | 787-712-8857
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Fax |
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Authorized Official
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Title or Position | DENTISTA
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Name | REYNALDO ROSA
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Credential | DMD
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Telephone | 787-712-8857
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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 |
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License Number State |
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