Provider Demographics
NPI:1710303755
Name:L .R. DENTAL C.S.P.
Entity Type:Organization
Organization Name:L .R. DENTAL C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIVES PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-783-1259
Mailing Address - Street 1:1270 CALLE 54 SE
Mailing Address - Street 2:URB LA RIVIERA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-783-1259
Mailing Address - Fax:
Practice Address - Street 1:1270 CALLE 54 SE
Practice Address - Street 2:URB LA RIVIERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-783-1259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD1452261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental