Provider Demographics
NPI:1144596537
Name:CENTRO DE PERIODONCIA E IMPLANTES DE PR, PSC
Entity Type:Organization
Organization Name:CENTRO DE PERIODONCIA E IMPLANTES DE PR, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REINALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:787-781-2737
Mailing Address - Street 1:101 AVE SAN PATRICIO
Mailing Address - Street 2:STE. 830
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-781-2737
Mailing Address - Fax:787-783-7320
Practice Address - Street 1:101 AVE SAN PATRICIO
Practice Address - Street 2:STE. 830
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-781-2737
Practice Address - Fax:787-783-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty