1487779500 NPI number — DENTISTAS ALEMANY PONS

Table of content: KAROL A. WILSON PT (NPI 1346344389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487779500 NPI number — DENTISTAS ALEMANY PONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTISTAS ALEMANY PONS
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:
1487779500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 CALLE AMATISTA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00682-2504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-832-3233
Provider Business Mailing Address Fax Number:
787-834-2770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MAYAGUEZ MALL 975 AVE HOSTOS
Provider Second Line Business Practice Location Address:
SUITE 2205
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-1257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-833-5580
Provider Business Practice Location Address Fax Number:
787-834-2770
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALEMANY PONS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
787-833-5580

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1616 , 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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