Provider Demographics
NPI:1821340308
Name:ENDODONCIA DEL NORESTE, PSC
Entity Type:Organization
Organization Name:ENDODONCIA DEL NORESTE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/ ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES-ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-757-0548
Mailing Address - Street 1:60 CALLE CRISTOBAL COLON
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-3616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROBERTO CLEMENTE AVENUE
Practice Address - Street 2:ESQ CALLE 99 BLOQUE 89 #1
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-0548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2869261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental