Provider Demographics
NPI:1033143102
Name:PEDRAZA, JAIME ALBERTO (DDS)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ALBERTO
Last Name:PEDRAZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1602
Mailing Address - Country:US
Mailing Address - Phone:787-450-6599
Mailing Address - Fax:
Practice Address - Street 1:CALLE1 HH1 RIVERVIEW
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00962-6070
Practice Address - Country:US
Practice Address - Phone:787-275-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7940004OtherHUMANA
PR041784OtherTRIPLE S
PR1033143102OtherMCS LIFE
PR6954OtherFIRST MEDICAL
PRD00103OtherPLAN DE SALUD HOSPITAL ME
PR6954OtherFIRST MEDICAL