Provider Demographics
NPI:1407127079
Name:ENDODONCIA Y ESTETICA DENTAL C.S.P
Entity Type:Organization
Organization Name:ENDODONCIA Y ESTETICA DENTAL C.S.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:FERRARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:787-399-8875
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0988
Mailing Address - Country:US
Mailing Address - Phone:787-399-8875
Mailing Address - Fax:
Practice Address - Street 1:AVE. MUNOZ RIVERA ESQ. VICTORIA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-431-6762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2889122300000X
PR28881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty