Provider Demographics
NPI:1720618515
Name:LABOY-CORREA, AMANDA MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIA
Last Name:LABOY-CORREA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AVE CARLOS CHARDON, QUANTUM METROCENTER #002N
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1730
Mailing Address - Country:US
Mailing Address - Phone:787-548-5720
Mailing Address - Fax:
Practice Address - Street 1:120 AVE CARLOS CHARDON, QUANTUM METROCENTER #002N
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-0091
Practice Address - Country:US
Practice Address - Phone:787-548-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice