Provider Demographics
NPI:1093883399
Name:FRONTERO, ENRIQUE JR (DMD)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:FRONTERO
Suffix:JR
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 1:201 DEDIEGO AVE
Mailing Address - Street 2:PLAZA SAN FRANCISCO SUITE 205
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-764-6138
Mailing Address - Fax:787-764-6157
Practice Address - Street 1:201 DEDIEGO AVE
Practice Address - Street 2:PLAZA SAN FRAN SUITE 205
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-764-6138
Practice Address - Fax:787-764-6157
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice