Provider Demographics
NPI:1568427268
Name:AMADOR, ILEANE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ILEANE
Middle Name:
Last Name:AMADOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3994
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:787-356-2080
Mailing Address - Fax:787-846-5010
Practice Address - Street 1:AVE ESCOBAR #13
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-846-5010
Practice Address - Fax:787-846-5010
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist