Provider Demographics
NPI:1245075035
Name:CENTRO DE BIENESTAR DENTAL
Entity type:Organization
Organization Name:CENTRO DE BIENESTAR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:YATNEE
Authorized Official - Middle Name:ALYS
Authorized Official - Last Name:ENCARNACION GINES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-247-9084
Mailing Address - Street 1:RR 10 BOX 10560
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9515
Mailing Address - Country:US
Mailing Address - Phone:787-247-9084
Mailing Address - Fax:
Practice Address - Street 1:CALLE 13 BARCELO
Practice Address - Street 2:
Practice Address - City:BARRANQUITA
Practice Address - State:PR
Practice Address - Zip Code:00956-1710
Practice Address - Country:US
Practice Address - Phone:787-857-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental