1578977369 NPI number — OFICINA DENTAL DRA LAURA DEL FIERRO C LLC

Table of content: (NPI 1578977369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578977369 NPI number — OFICINA DENTAL DRA LAURA DEL FIERRO C LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OFICINA DENTAL DRA LAURA DEL FIERRO C LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Middle Name:
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NPI Number Information

NPI Number:
1578977369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5302 CALLE CERRILLO
Provider Second Line Business Mailing Address:
AA3 RIVER VALLEY TOWN PARK
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-887-3595
Provider Business Mailing Address Fax Number:
888-988-1781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO COMERCIAL VILLAS DE RIO GRANDE
Provider Second Line Business Practice Location Address:
CALLE PIMENTEL PRIMER PISO
Provider Business Practice Location Address City Name:
RIO GRANDE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-887-3595
Provider Business Practice Location Address Fax Number:
787-888-2007
Provider Enumeration Date:
06/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DEL FIERRO
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
ALEJANDRA
Authorized Official Title or Position:
DENTIST/PRESIDENT
Authorized Official Telephone Number:
787-887-3595

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  2748 , 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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