Provider Demographics
NPI:1720281793
Name:INSTITUTO DENTAL
Entity Type:Organization
Organization Name:INSTITUTO DENTAL
Other - Org Name:CENTRO DIANGOSTICO INTEGRAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:SOLTERZ-ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-726-0440
Mailing Address - Street 1:1801 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1900
Mailing Address - Country:US
Mailing Address - Phone:787-726-0440
Mailing Address - Fax:787-727-5574
Practice Address - Street 1:1801 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 405
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1900
Practice Address - Country:US
Practice Address - Phone:787-726-0440
Practice Address - Fax:787-727-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1540122300000X
PR19651223P0221X
PR23081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherPR TAX ID