Provider Demographics
NPI:1780876995
Name:SAN JUAN PEDIATRIC DENTAL HOME PSC
Entity type:Organization
Organization Name:SAN JUAN PEDIATRIC DENTAL HOME PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:JOAQUIN
Authorized Official - Last Name:AYMAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-765-2679
Mailing Address - Street 1:282 AVE PINERO STE 211
Mailing Address - Street 2:PLAZA EL AMAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-3918
Mailing Address - Country:US
Mailing Address - Phone:787-765-2679
Mailing Address - Fax:787-753-3934
Practice Address - Street 1:282 AVE PINERO STE 211
Practice Address - Street 2:PLAZA EL AMAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-3918
Practice Address - Country:US
Practice Address - Phone:787-765-2679
Practice Address - Fax:787-753-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1980261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental