Provider Demographics
NPI:1336572866
Name:MAGIC-DENTAL INC.
Entity Type:Organization
Organization Name:MAGIC-DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:KARINA
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-579-4919
Mailing Address - Street 1:35 JUAN CARLOS DE BORBON
Mailing Address - Street 2:SUITE 67 PMB 328
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5375
Mailing Address - Country:US
Mailing Address - Phone:787-579-4919
Mailing Address - Fax:787-782-0233
Practice Address - Street 1:823 AVE SAN PATRICIO
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1311
Practice Address - Country:US
Practice Address - Phone:787-781-8058
Practice Address - Fax:787-781-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental