Provider Demographics
NPI:1710593017
Name:BOARD CERTIFIED ORTHODONTICS LLC
Entity Type:Organization
Organization Name:BOARD CERTIFIED ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ-FEBO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-460-0283
Mailing Address - Street 1:URB EL MIRADOR DE CUPEY
Mailing Address - Street 2:A6 CALLE 2
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7545
Mailing Address - Country:US
Mailing Address - Phone:787-460-0283
Mailing Address - Fax:
Practice Address - Street 1:URB. VILLA DEL ROSARIO
Practice Address - Street 2:CALLE 2, A3
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-460-0283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty