Provider Demographics
NPI:1083927818
Name:CENTRO AVANZADO DE ODONTOLOGIA ESTETICA,CSP
Entity Type:Organization
Organization Name:CENTRO AVANZADO DE ODONTOLOGIA ESTETICA,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-447-7078
Mailing Address - Street 1:PO BOX 1378
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1378
Mailing Address - Country:US
Mailing Address - Phone:787-447-7078
Mailing Address - Fax:787-735-1741
Practice Address - Street 1:165 CALLE BALDORIOTY N
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3234
Practice Address - Country:US
Practice Address - Phone:787-735-1741
Practice Address - Fax:787-735-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty