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General NPI Number Information
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NPI Number | 1952140642
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Entity Type | Organization
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Legal Business Name | OMAR EL DENTISTA LLC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | CARR 152 KM 7.6 BO QUEBRADILLAS SEC LOS LOPEZ
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City | BARRANQUITAS
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State | PR
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Zip | 00794
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Country | US
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Telephone | 787-370-4346
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Fax |
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Provider Business Mailing Address
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Address Line | HC 71 BOX 3278
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City | NARANJITO
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State | PR
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Zip | 00719-9536
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Country | US
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Telephone | 787-370-4346
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | OMAR RIVERA LOPEZ
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Credential | DMD
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Telephone | 787-370-4346
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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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