MEDICARE: MIGUEL PASTRANA LABORDE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2043	PR
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry	DN 13518	FL

General Provider Information

NPI Number	:	1093839771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL PASTRANA LABORDE DMD

Provider Business Mailing Address
First Line	:	PO BOX 1678
Second Line	:
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-1678
Country	:	US
Telephone Number	:	787-280-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR 111 KM 17.9
Second Line	:	BO GUATEMALA
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-3216
Country	:	US
Telephone Number	:	787-280-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	03/09/2026

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