Provider Demographics
NPI:1295852598
Name:ESCUELA DE ODONTOLOGIA
Entity Type:Organization
Organization Name:ESCUELA DE ODONTOLOGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTAN PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Mailing Address - Fax:
Practice Address - Street 1:AVE BARBOSA 608
Practice Address - Street 2:CLINICA DENTAL COMUNITARIA CANTERA SUITE 4
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-1274
Practice Address - Country:US
Practice Address - Phone:787-728-4190
Practice Address - Fax:787-728-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty