Provider Demographics
NPI:1619193349
Name:SERRACANTE, RENAN (ORTHODONTIC)
Entity Type:Individual
Prefix:DR
First Name:RENAN
Middle Name:
Last Name:SERRACANTE
Suffix:
Gender:M
Credentials:ORTHODONTIC
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 65
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0065
Mailing Address - Country:US
Mailing Address - Phone:787-735-4949
Mailing Address - Fax:787-735-1645
Practice Address - Street 1:10 CALLE MERCEDITA SERRALLES
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3902
Practice Address - Country:US
Practice Address - Phone:787-735-4949
Practice Address - Fax:787-735-1645
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics