Provider Demographics
NPI:1083882831
Name:ANGEL OTERO DENTAL OFFICE PSC
Entity Type:Organization
Organization Name:ANGEL OTERO DENTAL OFFICE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-758-0243
Mailing Address - Street 1:J4 CALLE RUISENOR
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3345
Mailing Address - Country:US
Mailing Address - Phone:787-758-0243
Mailing Address - Fax:787-282-8755
Practice Address - Street 1:FDR 525 SUITE 611
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-0243
Practice Address - Fax:787-282-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2376261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental