Provider Demographics
NPI:1720206535
Name:PENUELAS DENTAL CLINIC
Entity Type:Organization
Organization Name:PENUELAS DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISTA
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-836-3333
Mailing Address - Street 1:628 PEDRO VELAZQUEZ AURORA 3B
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624
Mailing Address - Country:US
Mailing Address - Phone:787-836-3333
Mailing Address - Fax:787-836-1729
Practice Address - Street 1:628 PEDRO VELAZQUEZ AURORA 3B
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-836-3333
Practice Address - Fax:787-836-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty