Provider Demographics
NPI:1689972143
Name:DORADO FAMILY DENTAL CENTER PSC
Entity Type:Organization
Organization Name:DORADO FAMILY DENTAL CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUPITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-372-4309
Mailing Address - Street 1:410 CALLE MENDEZ VIGO
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4800
Mailing Address - Country:US
Mailing Address - Phone:787-626-0755
Mailing Address - Fax:787-626-0758
Practice Address - Street 1:410 CALLE MENDEZ VIGO
Practice Address - Street 2:SUITE 102
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4800
Practice Address - Country:US
Practice Address - Phone:787-626-0755
Practice Address - Fax:787-626-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1854261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental