Provider Demographics
NPI:1801412010
Name:DENTAL SERVICES ORGANIZATION LLC
Entity Type:Organization
Organization Name:DENTAL SERVICES ORGANIZATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA/APPEALS AND GRIEVANC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES TORREO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:787-622-3000
Mailing Address - Street 1:PO BOX 71114
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8014
Mailing Address - Country:US
Mailing Address - Phone:787-622-3000
Mailing Address - Fax:787-620-5384
Practice Address - Street 1:CENTRO COMERCIAL PLAZA RIAL
Practice Address - Street 2:CARR 185 KM 0.9
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-622-3000
Practice Address - Fax:787-620-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251B00000XAgenciesCase Management
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No291U00000XLaboratoriesClinical Medical Laboratory
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No3336C0002XSuppliersPharmacyClinic Pharmacy