Provider Demographics
NPI:1467594721
Name:PAGAN, ALEXIS R (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:R
Last Name:PAGAN
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:253 CALLE SAN JORGE STE I-A
Mailing Address - Street 2:SAN JORGE II MEDICAL BUILDING
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3307
Mailing Address - Country:US
Mailing Address - Phone:787-727-3838
Mailing Address - Fax:787-727-3821
Practice Address - Street 1:253 CALLE SAN JORGE STE I-A
Practice Address - Street 2:SAN JORGE II MEDICAL BUILDING
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3307
Practice Address - Country:US
Practice Address - Phone:787-727-3838
Practice Address - Fax:787-727-3821
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PR24241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry