Provider Demographics
NPI:1114172681
Name:INSTITUTO DENTAL DEL SUR.C.S.P.
Entity Type:Organization
Organization Name:INSTITUTO DENTAL DEL SUR.C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSSO-TRIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-837-2314
Mailing Address - Street 1:54 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1608
Mailing Address - Country:US
Mailing Address - Phone:787-837-2314
Mailing Address - Fax:
Practice Address - Street 1:54 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1608
Practice Address - Country:US
Practice Address - Phone:787-837-2314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty