MEDICARE: LDA DENTAL SERVICES 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	:	1467328294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDA DENTAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1452 ASHFORD AVE SUITE 411A
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907
Country	:	US
Telephone Number	:	787-341-0610
Fax Number	:

Provider Business Practice Location Address
First Line	:	COND PLZ
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-4442
Country	:	US
Telephone Number	:	787-341-0610
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LIRIE DOYLE
Credential	:
Telephone Number	:	787-237-9413

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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Directions to “LDA DENTAL SERVICES LLC ” Practice Location

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