Provider Demographics
NPI:1073196770
Name:SRC DENTAL DREAMS LLC
Entity Type:Organization
Organization Name:SRC DENTAL DREAMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHARIS
Authorized Official - Middle Name:MARI
Authorized Official - Last Name:RAMOS COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-922-5857
Mailing Address - Street 1:URB VEREDAS CAMINO LAS PALMAS
Mailing Address - Street 2:253
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-922-5857
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 653 KM 2.2 SECTOR BARRANCA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-922-5857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty