Provider Demographics
NPI:1750453114
Name:GRILLO, JUAN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:E
Last Name:GRILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0412
Mailing Address - Country:US
Mailing Address - Phone:787-848-8886
Mailing Address - Fax:
Practice Address - Street 1:1980 PONCE BYP STE 104
Practice Address - Street 2:PUEBLO XTRA SHOPPING COURT
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1904
Practice Address - Country:US
Practice Address - Phone:787-848-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist