Provider Demographics
NPI:1215585906
Name:QUALITY DENTAL GROUP
Entity Type:Organization
Organization Name:QUALITY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:DIAZ RUBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-765-8394
Mailing Address - Street 1:735 AVE PONCE DE LEON STE 713
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5030
Mailing Address - Country:US
Mailing Address - Phone:787-765-8394
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON STE 713
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5030
Practice Address - Country:US
Practice Address - Phone:787-765-8394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty