Provider Demographics
NPI:1134228349
Name:IBANEZ, BEATRIZ ELENA (DMD)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:ELENA
Last Name:IBANEZ
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 188
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0188
Mailing Address - Country:US
Mailing Address - Phone:797-892-1010
Mailing Address - Fax:787-892-1011
Practice Address - Street 1:SAN GERMAN MEDICAL PLAZA CARR # 2 KM174
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0188
Practice Address - Country:US
Practice Address - Phone:787-892-1010
Practice Address - Fax:787-892-1011
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1759OtherLICENSE NUMBER