Provider Demographics
NPI:1649642117
Name:CLINICA DENTAL PLAZA, PSC
Entity type:Organization
Organization Name:CLINICA DENTAL PLAZA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOSA PADRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-645-8552
Mailing Address - Street 1:PO BOX 8761
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8761
Mailing Address - Country:US
Mailing Address - Phone:787-752-5700
Mailing Address - Fax:844-507-0291
Practice Address - Street 1:CAROLINA SHOPP CTR
Practice Address - Street 2:SUITE #30
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5672
Practice Address - Country:US
Practice Address - Phone:787-752-5700
Practice Address - Fax:844-507-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1333261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental