Provider Demographics
NPI:1467061150
Name:FHN PERIODONTICS, LLC
Entity Type:Organization
Organization Name:FHN PERIODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HERRERO NATER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-753-1419
Mailing Address - Street 1:201 AVE DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3505
Mailing Address - Country:US
Mailing Address - Phone:787-753-1419
Mailing Address - Fax:
Practice Address - Street 1:201 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3505
Practice Address - Country:US
Practice Address - Phone:787-753-1419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental