Provider Demographics
NPI:1376361824
Name:GC PERIODONTICS LLC
Entity type:Organization
Organization Name:GC PERIODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO GALLARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-422-6861
Mailing Address - Street 1:1511 AVE PONCE DE LEON
Mailing Address - Street 2:TORRE 900 APT. 994
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-371-0209
Mailing Address - Fax:
Practice Address - Street 1:INSTITUTO SAN PABLO
Practice Address - Street 2:CALLE SANTA CRUZ #66 SUITE 103
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-925-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty