=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952799926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WE CARE DENTAL L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2014
-----------------------------------------------------
Last Update Date | 03/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | #2 SANTA ISABEL PROFESSIONAL BUILDING SUITE 207 BO. FELICIA
-----------------------------------------------------
City | SANTA ISABEL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-601-7626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 801259
-----------------------------------------------------
City | COTO LAUREL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00780-1259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-601-7626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JUANCARLOS J ROSARIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-601-7626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | D2464
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------