Provider Demographics
NPI:1518157593
Name:BASIC DENTAL CLINIC
Entity Type:Organization
Organization Name:BASIC DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-637-0084
Mailing Address - Street 1:AVE MUNOZ RIVERA 402
Mailing Address - Street 2:
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-751-6784
Mailing Address - Fax:
Practice Address - Street 1:AVE MUNOZ RIVERA 402
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-6784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty