Provider Demographics
NPI:1538466826
Name:CONSULTORIO Y LABORATORIO DENTAL BARBOSA
Entity Type:Organization
Organization Name:CONSULTORIO Y LABORATORIO DENTAL BARBOSA
Other - Org Name:CONSULTORIO Y LABORATORIO DENTAL BARBOSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:FAMILIA GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-275-4019
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00963-0276
Mailing Address - Country:US
Mailing Address - Phone:787-275-4019
Mailing Address - Fax:787-275-4018
Practice Address - Street 1:119 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-6070
Practice Address - Country:US
Practice Address - Phone:787-275-4019
Practice Address - Fax:787-275-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty