Provider Demographics
NPI:1720291073
Name:ORTHODONTIC CENTERS OF PUERTO RICO INC.
Entity Type:Organization
Organization Name:ORTHODONTIC CENTERS OF PUERTO RICO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:EMMANUELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMS, MS
Authorized Official - Phone:787-834-2003
Mailing Address - Street 1:55 MEDITACION
Mailing Address - Street 2:SUITE 7 B
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-834-2003
Mailing Address - Fax:787-833-5272
Practice Address - Street 1:55 MEDITACION
Practice Address - Street 2:SUITE 7 B
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-2003
Practice Address - Fax:787-833-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty