Provider Demographics
NPI:1770368805
Name:DENTAL SERVICES ORGANIZATION, LLC
Entity type:Organization
Organization Name:DENTAL SERVICES ORGANIZATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:787-622-3000
Mailing Address - Street 1:PO BOX 71114
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0000
Mailing Address - Country:US
Mailing Address - Phone:787-622-3000
Mailing Address - Fax:787-620-5384
Practice Address - Street 1:BOULEVARD PLAZA DE RIO RAMAL 3
Practice Address - Street 2:AVE NICANOR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00741-0000
Practice Address - Country:US
Practice Address - Phone:787-622-3000
Practice Address - Fax:787-620-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039465701Medicaid