Provider Demographics
NPI:1720483191
Name:CENTRO GRUPO DENTAL DSPDI
Entity Type:Organization
Organization Name:CENTRO GRUPO DENTAL DSPDI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-2929
Mailing Address - Street 1:PO BOX 70184
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8184
Mailing Address - Country:US
Mailing Address - Phone:787-765-2929
Mailing Address - Fax:
Practice Address - Street 1:100 AVE. LAUREL
Practice Address - Street 2:HOSPITAL UNIVERSITARIO DR. RAMON RUIZ ARNAU
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-765-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty