Provider Demographics
NPI:1477941946
Name:CLINICA DENTAL DR. EDWIN ROSA, CSP
Entity Type:Organization
Organization Name:CLINICA DENTAL DR. EDWIN ROSA, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-915-3015
Mailing Address - Street 1:PO BOX 70344
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-915-3015
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 29.3
Practice Address - Street 2:PARCELAS CARMEN
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-317-9168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2537261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery