Provider Demographics
NPI:1770831422
Name:DENTAL IMAGE PSC
Entity Type:Organization
Organization Name:DENTAL IMAGE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEANSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-781-4379
Mailing Address - Street 1:AVE. AMERICO MIRANDA
Mailing Address - Street 2:#1578 CAPARRA TERRACE
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-781-4379
Mailing Address - Fax:787-781-4379
Practice Address - Street 1:AVE. AMERICO MIRANDA
Practice Address - Street 2:#1578 CAPARRA TERRACE
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921-2213
Practice Address - Country:US
Practice Address - Phone:787-781-4379
Practice Address - Fax:787-781-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2193302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization