Provider Demographics
NPI:1578345518
Name:DENTAL SERVICES ORGANIZATION LLC
Entity Type:Organization
Organization Name:DENTAL SERVICES ORGANIZATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-622-3000
Mailing Address - Street 1:PO BOX 71114
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8014
Mailing Address - Country:US
Mailing Address - Phone:787-622-3000
Mailing Address - Fax:787-622-5384
Practice Address - Street 1:MALL PLAZA RIAL
Practice Address - Street 2:CARR 185 4A 4B KM 0.9
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:939-545-1399
Practice Address - Fax:787-622-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039465700Medicaid