Provider Demographics
NPI:1255816385
Name:ADVANCED DENTAL SERVICE
Entity type:Organization
Organization Name:ADVANCED DENTAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-877-7000
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1144
Mailing Address - Country:US
Mailing Address - Phone:787-877-7000
Mailing Address - Fax:787-877-0115
Practice Address - Street 1:CARR 110 INT PR 125
Practice Address - Street 2:MOCA MEDICAL PLAZA 211
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-7000
Practice Address - Fax:787-877-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental