Provider Demographics
NPI:1952828782
Name:CONDADO ORTHODONTICS PSC
Entity Type:Organization
Organization Name:CONDADO ORTHODONTICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-523-6949
Mailing Address - Street 1:100 CALLE DEL MUELLE APT 2204
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2641
Mailing Address - Country:US
Mailing Address - Phone:787-415-2868
Mailing Address - Fax:
Practice Address - Street 1:1452 AVE ASHFORD STE 406
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-415-2868
Practice Address - Fax:787-415-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty