1295852598 NPI number — ESCUELA DE ODONTOLOGIA

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 1295852598 NPI number — ESCUELA DE ODONTOLOGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESCUELA DE ODONTOLOGIA
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:
1295852598
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:
PO BOX 365067
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:
00936-5067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE BARBOSA 608
Provider Second Line Business Practice Location Address:
CLINICA DENTAL COMUNITARIA CANTERA SUITE 4
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00919-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-4190
Provider Business Practice Location Address Fax Number:
787-728-4190
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOLINA
Authorized Official First Name:
DAMARIS
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTAN PROFESSOR
Authorized Official Telephone Number:
787-758-2525

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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