MEDICARE: DR. CLARA E DE JESUS 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	1223E0200X	Endodontics	1750	PR

General Provider Information

NPI Number	:	1114923653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARA E DE JESUS DMD

Provider Business Mailing Address
First Line	:	570 CALLE NAPOLES
Second Line	:	STE 203
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4605
Country	:	US
Telephone Number	:	787-760-3260
Fax Number	:	787-748-5177

Provider Business Practice Location Address
First Line	:	570 CALLE NAPOLES
Second Line	:	STE 203
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4605
Country	:	US
Telephone Number	:	787-760-3260
Fax Number	:	787-748-5177

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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