Provider Demographics
NPI:1326381815
Name:A COSMETIC DENTAL CENTER
Entity Type:Organization
Organization Name:A COSMETIC DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:NMI
Authorized Official - Last Name:FISCHBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-888-3493
Mailing Address - Street 1:PO BOX 2017
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-2017
Mailing Address - Country:US
Mailing Address - Phone:787-888-3493
Mailing Address - Fax:787-888-3493
Practice Address - Street 1:CARR #3 KM.21 LOCAL 2 MARGINAL LA DOLORES
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-888-3493
Practice Address - Fax:787-888-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1722261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental