Provider Demographics
NPI:1679951701
Name:ROSALEDA DENTAL CARE,PSC
Entity Type:Organization
Organization Name:ROSALEDA DENTAL CARE,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-701-2613
Mailing Address - Street 1:350 VIA AVENTURA
Mailing Address - Street 2:APT#6602 ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6184
Mailing Address - Country:US
Mailing Address - Phone:787-701-2613
Mailing Address - Fax:787-701-2613
Practice Address - Street 1:AL4 AVE FIDALGO DIAZ
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-0983
Practice Address - Country:US
Practice Address - Phone:787-701-2613
Practice Address - Fax:787-701-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2392261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental