Provider Demographics
NPI:1013202696
Name:GARLAND DE JESUS, TYRENE JOAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYRENE
Middle Name:JOAN
Last Name:GARLAND DE JESUS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 CALLE PARANA
Mailing Address - Street 2:URB. EL CEREZAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3144
Mailing Address - Country:US
Mailing Address - Phone:787-613-1026
Mailing Address - Fax:787-759-7181
Practice Address - Street 1:1692 CALLE PARANA
Practice Address - Street 2:URB. EL CEREZAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-613-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice