Provider Demographics
NPI:1063479616
Name:BETANCES RAHOLA, LUIS ENRIQUE (DMD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ENRIQUE
Last Name:BETANCES RAHOLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 CALLE 14 # A
Mailing Address - Street 2:BO OBRERO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-4129
Mailing Address - Country:US
Mailing Address - Phone:787-908-2992
Mailing Address - Fax:
Practice Address - Street 1:COND CONDESA DEL MAR # 3103
Practice Address - Street 2:APARTAMENTO 1207 ISLA VERDE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-4900
Practice Address - Country:US
Practice Address - Phone:787-908-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist