Provider Demographics
NPI:1295276004
Name:MERILE WCC DENTAL SERVICES
Entity type:Organization
Organization Name:MERILE WCC DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-780-8176
Mailing Address - Street 1:PO BOX 6984
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5984
Mailing Address - Country:US
Mailing Address - Phone:787-780-8176
Mailing Address - Fax:
Practice Address - Street 1:DC8 AVE MINILLAS
Practice Address - Street 2:STA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-780-8176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2280261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental