Provider Demographics
NPI:1790244119
Name:FAMILY PRO SMILES
Entity Type:Organization
Organization Name:FAMILY PRO SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:NIEVES MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-877-2500
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0400
Mailing Address - Country:US
Mailing Address - Phone:787-877-2500
Mailing Address - Fax:787-877-2505
Practice Address - Street 1:EDIFICIO COLON PLAZA
Practice Address - Street 2:CARR 110 KM 12.4
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0000
Practice Address - Country:US
Practice Address - Phone:787-877-2500
Practice Address - Fax:787-877-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental