MEDICARE: DR. LINA E LAROTTA 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	1223G0001X	General Practice Dentistry	2447	PR

General Provider Information

NPI Number	:	1518077833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINA E LAROTTA DMD

Provider Business Mailing Address
First Line	:	PO BOX 70344
Second Line	:	PMB 368
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8344
Country	:	US
Telephone Number	:	787-764-1590
Fax Number	:	787-754-4363

Provider Business Practice Location Address
First Line	:	368 CALLE DE DIEGO
Second Line	:	OFIC. C-6
City	:	SAN JUAN
State	:	PR
Zip	:	00923-2916
Country	:	US
Telephone Number	:	787-764-1590
Fax Number	:	787-754-4363

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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