1679010755 NPI number — CARIBE DENTAL GALLERY

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 1679010755 NPI number — CARIBE DENTAL GALLERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARIBE DENTAL GALLERY
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:
1679010755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUITE 214 CARRETERA #2 KM 29.7
Provider Second Line Business Mailing Address:
CENTRO GRAN CARIBE
Provider Business Mailing Address City Name:
VEGA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-883-6560
Provider Business Mailing Address Fax Number:
787-270-6286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE 208 CARRETERA #2 KM 29.7
Provider Second Line Business Practice Location Address:
CENTRO GRAN CARIBE
Provider Business Practice Location Address City Name:
VEGA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-883-6560
Provider Business Practice Location Address Fax Number:
787-270-6286
Provider Enumeration Date:
01/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ECHANDY
Authorized Official First Name:
IRMA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PEDIATRIC DENTIST
Authorized Official Telephone Number:
787-883-6560

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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