Provider Demographics
NPI:1710255070
Name:OFICINA DENTAL DRA AILEEN E SMITH
Entity Type:Organization
Organization Name:OFICINA DENTAL DRA AILEEN E SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-852-1370
Mailing Address - Street 1:54 CALLE PADRE RIVERA W
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3649
Mailing Address - Country:US
Mailing Address - Phone:787-852-1370
Mailing Address - Fax:787-285-5388
Practice Address - Street 1:54 CALLE PADRE RIVERA W
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3649
Practice Address - Country:US
Practice Address - Phone:787-852-1370
Practice Address - Fax:787-285-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty