Provider Demographics
NPI:1710273966
Name:EJ DENTAL P.S.C.
Entity Type:Organization
Organization Name:EJ DENTAL P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTINIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-798-9424
Mailing Address - Street 1:AVE LAUREL 3R40
Mailing Address - Street 2:LOMAS VERDES
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE LAUREL 3R40
Practice Address - Street 2:LOMAS VERDES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-798-9424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental