Provider Demographics
NPI:1356717193
Name:CENTRO DENTAL ALTOMAR P.S.C.
Entity type:Organization
Organization Name:CENTRO DENTAL ALTOMAR P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:FONTANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-720-9007
Mailing Address - Street 1:1353 CARR. 19
Mailing Address - Street 2:PMB 226
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2700
Mailing Address - Country:US
Mailing Address - Phone:787-720-9007
Mailing Address - Fax:787-720-9008
Practice Address - Street 1:1781 AVE PAZ GRANELA
Practice Address - Street 2:SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3626
Practice Address - Country:US
Practice Address - Phone:787-720-9007
Practice Address - Fax:787-720-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty