Provider Demographics
NPI:1801857768
Name:ROSARIO, MANUEL ANGEL (DDS)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANGEL
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:DDS
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 1829
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1829
Mailing Address - Country:US
Mailing Address - Phone:787-786-4180
Mailing Address - Fax:787-786-5723
Practice Address - Street 1:#59 CALLE SANTA CRUZ
Practice Address - Street 2:STE 200
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-4180
Practice Address - Fax:787-786-5723
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist