1437291101 NPI number — SMILES 4 FAMILY DENTAL OFFICE, P.S.C.

Table of content: (NPI 1437291101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437291101 NPI number — SMILES 4 FAMILY DENTAL OFFICE, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMILES 4 FAMILY DENTAL OFFICE, P.S.C.
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:
1437291101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ESTANCIAS SIERVAS DE MARIA
Provider Second Line Business Mailing Address:
64 CALLE SANTA ANA
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778-9314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-703-3378
Provider Business Mailing Address Fax Number:
787-703-3378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VALLE TOLIMA
Provider Second Line Business Practice Location Address:
G 38 AVE. PRINCIPAL
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-703-3378
Provider Business Practice Location Address Fax Number:
787-703-3378
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO-MARTINEZ
Authorized Official First Name:
VIVIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-707-3378

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D02644 , 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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