MEDICARE: DR. JUAN RAMON VIVES PAGAN D.M.D.

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	001452	PR

General Provider Information

NPI Number	:	1457361057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN RAMON VIVES PAGAN D.M.D.

Provider Business Mailing Address
First Line	:	1270 CALLE 54 SE
Second Line	:	URBANIZACION LA RIVERA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3141
Country	:	US
Telephone Number	:	787-783-1259
Fax Number	:	939-204-0294

Provider Business Practice Location Address
First Line	:	1270 CALLE 54 SE
Second Line	:	URBANIZACION LA RIVERA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3141
Country	:	US
Telephone Number	:	787-783-1259
Fax Number	:	939-204-0294

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/21/2022

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