1144681933 NPI number — DEPARTMENT OF HEALTH

Table of content: DR. WILLIAM PAUL FERNALD DDS (NPI 1487719449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144681933 NPI number — DEPARTMENT OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTMENT OF HEALTH
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:
CLINICA DENTAL RINCON
Provider Other Organization Name Type Code:
3
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:
1144681933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70184
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-8184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-765-2929
Provider Business Mailing Address Fax Number:
787-522-6293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STATE ROAD 155 KM 13
Provider Second Line Business Practice Location Address:
BO PUEBLO
Provider Business Practice Location Address City Name:
RINCON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-765-2929
Provider Business Practice Location Address Fax Number:
787-522-6293
Provider Enumeration Date:
03/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CASES
Authorized Official First Name:
ANTONIO
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
DIRECTOR, ORAL HEALTH
Authorized Official Telephone Number:
787-765-2929

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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