Provider Demographics
NPI:1063506129
Name:CONSULTORIO DENTAL DRA OTERO PADRO
Entity Type:Organization
Organization Name:CONSULTORIO DENTAL DRA OTERO PADRO
Other - Org Name:CONSULTORIO DENTAL DRA OTERO PADRO
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTISTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-262-4074
Mailing Address - Street 1:P O BOX 5000 PMB 447
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-5000
Mailing Address - Country:US
Mailing Address - Phone:787-262-4074
Mailing Address - Fax:787-262-4074
Practice Address - Street 1:CARR 2 KM 93.9 BO MEMBRILLO
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-5000
Practice Address - Country:US
Practice Address - Phone:787-262-4074
Practice Address - Fax:787-262-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty