MEDICARE: DRA. TYRENE J GARLAND DE JESUS LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1295538387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRA. TYRENE J GARLAND DE JESUS LLC

Provider Business Mailing Address
First Line	:	1692 CALLE PARANA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3144
Country	:	US
Telephone Number	:	787-250-0273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1692 CALLE PARANA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3144
Country	:	US
Telephone Number	:	787-250-0273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TYRENE GARLAND
Credential	:	DMD
Telephone Number	:	787-613-1026

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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