Provider Demographics
NPI:1568237543
Name:GUAYNABO PERIODONTICS AND DENTAL IMPLANTS
Entity Type:Organization
Organization Name:GUAYNABO PERIODONTICS AND DENTAL IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REINALDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELIZ-GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-402-3746
Mailing Address - Street 1:GUAYNABO PERIODONTICS AND DENTAL IMPLANTS
Mailing Address - Street 2:1910 AVE. JESUS T. PINEIRO, SUITE 205
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1100
Mailing Address - Country:US
Mailing Address - Phone:787-402-3746
Mailing Address - Fax:787-834-3006
Practice Address - Street 1:GUAYNABO PERIODONTICS AND DENTAL IMPLANTS
Practice Address - Street 2:1910 AVE. JESUS T. PINEIRO, SUITE 205
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1100
Practice Address - Country:US
Practice Address - Phone:787-402-3746
Practice Address - Fax:787-834-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty