Provider Demographics
NPI:1245691740
Name:DENTAL CARE CENTER LLC
Entity type:Organization
Organization Name:DENTAL CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARRERO GRATACOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-675-4596
Mailing Address - Street 1:EL SENORIAL PLZ # 1326
Mailing Address - Street 2:CALLE SALUD SUITE 107
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1686
Mailing Address - Country:US
Mailing Address - Phone:787-675-4596
Mailing Address - Fax:
Practice Address - Street 1:OFICINA 211
Practice Address - Street 2:TORRE SAN CRISTOBAL,
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-675-4596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD12868-8261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental