Provider Demographics
NPI:1659698108
Name:AMANECER DENTAL CLINIC AND LAB
Entity Type:Organization
Organization Name:AMANECER DENTAL CLINIC AND LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECNICO DENTAL
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-562-9277
Mailing Address - Street 1:AVENIDA DE DIEGO 467 RIO PIEDRAS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-585-5569
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA DE DIEGO 467 RIO PIEDRAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-585-5569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1223G0001X, 126900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No126900000XDental ProvidersDental Laboratory TechnicianGroup - Single Specialty