Provider Demographics
NPI:1942200167
Name:ROSARIO, GRACIELA (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
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 2055
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2055
Mailing Address - Country:US
Mailing Address - Phone:787-735-5999
Mailing Address - Fax:
Practice Address - Street 1:CALLE PEDRO ROSARIO
Practice Address - Street 2:SUITE K-11
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-2055
Practice Address - Country:US
Practice Address - Phone:787-735-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist