1245587377 NPI number — CLINICA DENTAL DOZ

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 1245587377 NPI number — CLINICA DENTAL DOZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DENTAL DOZ
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:
1245587377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1075 CALLE MARGINAL VILLAMAR EXT. VILLAMAR
Provider Second Line Business Mailing Address:
ISLA VERDE
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00979-6346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-727-3550
Provider Business Mailing Address Fax Number:
787-728-6855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 CALLE MARGINAL VILLAMAR EXT. VILLAMAR
Provider Second Line Business Practice Location Address:
ISLA VERDE
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00979-6346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-727-3550
Provider Business Practice Location Address Fax Number:
787-728-6855
Provider Enumeration Date:
08/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SUAREZ
Authorized Official First Name:
WANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-727-3550

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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