Provider Demographics
NPI:1215370044
Name:ROC DENTAL SERVICES, P.SC.
Entity Type:Organization
Organization Name:ROC DENTAL SERVICES, P.SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-757-3080
Mailing Address - Street 1:AVE. ROBERTO CLEMENTE
Mailing Address - Street 2:24-8 VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-757-3080
Mailing Address - Fax:787-757-3080
Practice Address - Street 1:AVE. ROBERTO CLEMENTE
Practice Address - Street 2:24-8 VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-3080
Practice Address - Fax:787-757-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty