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General NPI Number Information
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NPI Number | 1952747545
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Entity Type | Organization
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Legal Business Name | PISHADENT,LLC
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 15 CALLE JARDINES S-1
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City | PONCE
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State | PR
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Zip | 00730-3547
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Country | US
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Telephone | 787-840-3435
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Fax |
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Provider Business Mailing Address
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Address Line | JARDINES FAGOT 15 S-1
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City | PONCE
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State | PR
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Zip | 00716
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Country | US
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Telephone | 787-840-3435
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Fax |
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Authorized Official
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Title or Position | ASSISTANT
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Name | MISS ROLON E GLENDA
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Credential | O
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Telephone | 787-630-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2871
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License Number State | PR
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