=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942393020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELENA M RAMOS DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URH MONTE BNSAS CALLE H A50
-----------------------------------------------------
City | FAJARDO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-860-1717
-----------------------------------------------------
Fax | 787-285-4319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 445
-----------------------------------------------------
City | PUERO REAL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00740-0445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-860-1717
-----------------------------------------------------
Fax | 787-285-4319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 1805
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------