1003119058 NPI number — LDV ENDODONTICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003119058 NPI number — LDV ENDODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LDV ENDODONTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003119058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250586
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00604-0586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-431-1158
Provider Business Mailing Address Fax Number:
787-880-4542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 AVE BARBOSA
Provider Second Line Business Practice Location Address:
ARECIBO MEDICAL PLAZA STE. 206
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-2799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-817-8030
Provider Business Practice Location Address Fax Number:
787-880-4542
Provider Enumeration Date:
12/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VISBAL
Authorized Official First Name:
LUZ
Authorized Official Middle Name:
DESIREE
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
787-431-1158

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  2829 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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