Provider Demographics
NPI:1053458323
Name:PAGAN, ELAINE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:M
Last Name:PAGAN
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:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1527
Mailing Address - Country:US
Mailing Address - Phone:787-756-6125
Mailing Address - Fax:787-756-6125
Practice Address - Street 1:MARGINAL SEIN
Practice Address - Street 2:CARRETERA #1 KM 16.1
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-756-6125
Practice Address - Fax:787-756-6125
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry