Provider Demographics
NPI:1487861704
Name:DENTALIA MEDIKA CORP
Entity Type:Organization
Organization Name:DENTALIA MEDIKA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:ORTIZ
Authorized Official - Last Name:PIETRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-776-3840
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0800
Mailing Address - Country:US
Mailing Address - Phone:787-776-3840
Mailing Address - Fax:787-276-2923
Practice Address - Street 1:CARR 857 0.4
Practice Address - Street 2:BO CANOVANILLAS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-776-3840
Practice Address - Fax:787-276-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherCRUZ AZUL