1225377658 NPI number — ALL DENTAL SERVICES INC

Table of content: (NPI 1225377658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225377658 NPI number — ALL DENTAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL DENTAL SERVICES INC
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:
1225377658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 FERNANDEZ JUNCOS AVE
Provider Second Line Business Mailing Address:
COND GOLDEN TRIANGLE REALTY
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-725-3440
Provider Business Mailing Address Fax Number:
787-724-4513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 FERNANDEZ JUNCOS AVE
Provider Second Line Business Practice Location Address:
COND GOLDEN TRIANGLE REALTY
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-725-3440
Provider Business Practice Location Address Fax Number:
787-724-4513
Provider Enumeration Date:
02/05/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-725-3440

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1520 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 1520 , 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)

  • Identifier: 1520 . This is a "DENTIST LICENSE OF PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".