Provider Demographics
NPI:1487860706
Name:UNIVERSIDAD DE PUERTO RICO RECINTO DE CIENCIAS MEDICAS
Entity Type:Organization
Organization Name:UNIVERSIDAD DE PUERTO RICO RECINTO DE CIENCIAS MEDICAS
Other - Org Name:ESCUELA DE ODONTOLOGIA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:X
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:787-757-1800
Mailing Address - Street 1:PO BOX 6021
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-6021
Mailing Address - Country:US
Mailing Address - Phone:787-757-1800
Mailing Address - Fax:
Practice Address - Street 1:CARR. 3 KM 8.3
Practice Address - Street 2:AVE. 65 DE INFANTERIA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984-6021
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty