Provider Demographics
NPI:1811039217
Name:J&ADENTALPSC
Entity Type:Organization
Organization Name:J&ADENTALPSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARIA
Authorized Official - Prefix:MISS
Authorized Official - First Name:AROCHO
Authorized Official - Middle Name:MEDINA
Authorized Official - Last Name:MARTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-830-2060
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690-0604
Mailing Address - Country:US
Mailing Address - Phone:787-830-2060
Mailing Address - Fax:787-830-2253
Practice Address - Street 1:2981 AVE MILITAR STE 1
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4075
Practice Address - Country:US
Practice Address - Phone:787-830-2060
Practice Address - Fax:787-830-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty