Provider Demographics
NPI:1043509102
Name:VR SMILE DESIGN
Entity Type:Organization
Organization Name:VR SMILE DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN RHYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-652-5550
Mailing Address - Street 1:400 CALLE CALAF
Mailing Address - Street 2:SUITE 361
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-652-5550
Mailing Address - Fax:787-652-5550
Practice Address - Street 1:OFFICE PARK III
Practice Address - Street 2:SUITE 205 ROAD #2
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-652-5550
Practice Address - Fax:787-652-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2858261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1154639524OtherNPI