Provider Demographics
NPI:1790856466
Name:ROSARIO, JUAN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:ROSARIO
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 922
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-260-3677
Mailing Address - Fax:787-260-6072
Practice Address - Street 1:CALLE COMERCIO #116
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-837-0124
Practice Address - Fax:787-260-6072
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR018401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice