Provider Demographics
NPI:1376909960
Name:WHITE TEETH DENTAL CARE, CORP.
Entity Type:Organization
Organization Name:WHITE TEETH DENTAL CARE, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-795-0320
Mailing Address - Street 1:HP13 CALLE AMALIA PAOLI
Mailing Address - Street 2:7MA SECCION LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3606
Mailing Address - Country:US
Mailing Address - Phone:787-795-0320
Mailing Address - Fax:787-795-0320
Practice Address - Street 1:HP13 CALLE AMALIA PAOLI
Practice Address - Street 2:7MA SECCION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3606
Practice Address - Country:US
Practice Address - Phone:787-795-0320
Practice Address - Fax:787-795-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty