Provider Demographics
NPI:1568031144
Name:DENTAL SERVICES NETWORK LLC
Entity Type:Organization
Organization Name:DENTAL SERVICES NETWORK LLC
Other - Org Name:DENTAL OFFICE MANAGEMENT SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-859-3367
Mailing Address - Street 1:1225 AVE PONCE DE LEON STE 606
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3907
Mailing Address - Country:US
Mailing Address - Phone:703-859-3367
Mailing Address - Fax:
Practice Address - Street 1:1225 AVE PONCE DE LEON STE 606
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3907
Practice Address - Country:US
Practice Address - Phone:703-859-3367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental