Provider Demographics
NPI:1720219900
Name:SERVICIOS DE ENDODONCIA DEL SUR
Entity Type:Organization
Organization Name:SERVICIOS DE ENDODONCIA DEL SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARHIMAZDA
Authorized Official - Middle Name:JIMENEZ
Authorized Official - Last Name:BAYONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-866-6406
Mailing Address - Street 1:ASHFORD MEDICAL PALZA CALLE ASHFORD#128 SUR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-866-6406
Mailing Address - Fax:
Practice Address - Street 1:ASHFORD MEDICAL PALZA CALLE ASHFORD#128 SUR
Practice Address - Street 2:SUITE 204
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-6406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty