Provider Demographics
NPI:1457388100
Name:MATOS, JOSE RAIMUNDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAIMUNDO
Last Name:MATOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70171
Mailing Address - Street 2:PMB60
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8171
Mailing Address - Country:US
Mailing Address - Phone:787-756-6125
Mailing Address - Fax:787-756-6125
Practice Address - Street 1:PLAZA P.R. SHOPPING CENTER MARGINAL SEIN
Practice Address - Street 2:KM. 16.1
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-756-6125
Practice Address - Fax:787-756-6125
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice