Provider Demographics
NPI:1710355979
Name:SAN JUAN PERIODONTICS
Entity Type:Organization
Organization Name:SAN JUAN PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-281-6681
Mailing Address - Street 1:6 CALLE PONCE
Mailing Address - Street 2:PEREZ MORRIS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5021
Mailing Address - Country:US
Mailing Address - Phone:787-281-6681
Mailing Address - Fax:787-250-1392
Practice Address - Street 1:6 CALLE PONCE
Practice Address - Street 2:PEREZ MORRIS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5021
Practice Address - Country:US
Practice Address - Phone:787-281-6681
Practice Address - Fax:787-250-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty