Provider Demographics
NPI:1295732147
Name:PATRICIO J. SUMAZA, DMD, CSP
Entity type:Organization
Organization Name:PATRICIO J. SUMAZA, DMD, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:SUMAZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-986-3636
Mailing Address - Street 1:351 AVE HOSTOS
Mailing Address - Street 2:SUITE 211, MEDICAL EMPORIUM
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1502
Mailing Address - Country:US
Mailing Address - Phone:787-986-3636
Mailing Address - Fax:787-805-1610
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:SUITE 211, MEDICAL EMPORIUM
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-986-3636
Practice Address - Fax:787-805-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24961223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty