Provider Demographics
NPI:1801156013
Name:DENTAL SPA P.S.C.
Entity type:Organization
Organization Name:DENTAL SPA P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVILA PABON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-725-4848
Mailing Address - Street 1:1479 AVE ASHFORD
Mailing Address - Street 2:COND. CONDADO DEL MAR APT # 410
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1583
Mailing Address - Country:US
Mailing Address - Phone:787-725-4848
Mailing Address - Fax:
Practice Address - Street 1:250 CALLE DEL PARQUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3200
Practice Address - Country:US
Practice Address - Phone:787-725-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty