Provider Demographics
NPI:1790115236
Name:CORREA & DEFENDINI DENTAL, P.S.C.
Entity Type:Organization
Organization Name:CORREA & DEFENDINI DENTAL, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-758-5120
Mailing Address - Street 1:1725 CALLE YANGTZE
Mailing Address - Street 2:RIO PIEDRAS HEIGHTS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3152
Mailing Address - Country:US
Mailing Address - Phone:787-758-5120
Mailing Address - Fax:787-763-3449
Practice Address - Street 1:1725 CALLE YANGTZE
Practice Address - Street 2:RIO PIEDRAS HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3152
Practice Address - Country:US
Practice Address - Phone:787-758-5120
Practice Address - Fax:787-763-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1770261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental