Provider Demographics
NPI:1003004714
Name:SERVICIOS ESPECIALIZADOS DE ORTODONCIA
Entity Type:Organization
Organization Name:SERVICIOS ESPECIALIZADOS DE ORTODONCIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD ,MS
Authorized Official - Phone:1787-758-1560
Mailing Address - Street 1:OFFICE 12 65 INFANTERIA
Mailing Address - Street 2:CENT COM LOS FLAMBOYANES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3314
Mailing Address - Country:US
Mailing Address - Phone:178-775-8156
Mailing Address - Fax:178-775-8151
Practice Address - Street 1:OFFICE 12 65 INFANTERIA RIO PIEDRAS
Practice Address - Street 2:CENT COM LOS FLAMBOYANES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3314
Practice Address - Country:US
Practice Address - Phone:178-775-8156
Practice Address - Fax:178-775-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR864261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental