MEDICARE: YAMIRA ROLDAN 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	2065	PR

General Provider Information

NPI Number	:	1538162961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMIRA ROLDAN DMD

Provider Business Mailing Address
First Line	:	PO BOX 250049
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00604-0049
Country	:	US
Telephone Number	:	787-891-3453
Fax Number	:	787-891-3453

Provider Business Practice Location Address
First Line	:	ROAD 459 KM 3.1
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603
Country	:	US
Telephone Number	:	787-891-3453
Fax Number	:	787-891-3453

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/13/2012

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