Provider Demographics
NPI:1417322249
Name:GARRATON, ALEXANDRA TERESA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:TERESA
Last Name:GARRATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 AVENIDA MUNOZ RIVERA
Mailing Address - Street 2:CONDOMINIO AQUABLUE 2705
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 AVE MUNOZ RIVERA
Practice Address - Street 2:CONDOMINIO AQUABLUE APT 2705
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-203-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0032061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics