MEDICARE: DR. AMANDA MARIA LABOY-CORREA 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	3339	PR

General Provider Information

NPI Number	:	1720618515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA MARIA LABOY-CORREA DMD

Provider Business Mailing Address
First Line	:	120 AVE CARLOS CHARDON, QUANTUM METROCENTER #002N
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-1730
Country	:	US
Telephone Number	:	787-548-5720
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 AVE CARLOS CHARDON, QUANTUM METROCENTER #002N
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-0091
Country	:	US
Telephone Number	:	787-548-5720
Fax Number	:

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

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	02/05/2020

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