Provider Demographics
NPI:1225181266
Name:UNIVERSITY OF PUERTO RICO MSC
Entity Type:Organization
Organization Name:UNIVERSITY OF PUERTO RICO MSC
Other - Org Name:PEDIATRIC UNIVERSITY HOSP DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYMAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-758-2525
Mailing Address - Street 1:PO BOX 365067
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-758-7871
Practice Address - Street 1:PEDIATRIC DENTISTRY CLINICS
Practice Address - Street 2:CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty