MEDICARE: DR. NORMA A IGLESIAS 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	1631	PR

General Provider Information

NPI Number	:	1750428231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMA A IGLESIAS DMD

Provider Business Mailing Address
First Line	:	654 AVE MUNOZ RIVERA
Second Line	:	SUITE 1111
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4123
Country	:	US
Telephone Number	:	787-764-9096
Fax Number	:

Provider Business Practice Location Address
First Line	:	654 PLAZA AVE MUNOZ RIVERA
Second Line	:	SUITE 1111
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4123
Country	:	US
Telephone Number	:	787-764-9096
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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