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General NPI Number Information
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NPI Number | 1952828782
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Entity Type | Organization
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Legal Business Name | CONDADO ORTHODONTICS PSC
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 1452 AVE ASHFORD STE 406
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 787-415-2868
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Fax | 787-415-2868
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Provider Business Mailing Address
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Address Line | 100 CALLE DEL MUELLE APT 2204
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City | SAN JUAN
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State | PR
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Zip | 00901-2641
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Country | US
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Telephone | 787-415-2868
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE A MORALES
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Credential | DMD
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Telephone | 787-523-6949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3156
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License Number State | PR
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