Provider Demographics
NPI:1801987409
Name:AMADOR, HUASCAR JOSE (DMD GPR)
Entity type:Individual
Prefix:DR
First Name:HUASCAR
Middle Name:JOSE
Last Name:AMADOR
Suffix:
Gender:M
Credentials:DMD GPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 AVE SAN PATRICIO
Mailing Address - Street 2:LAS LOMAS
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1311
Mailing Address - Country:US
Mailing Address - Phone:787-781-8058
Mailing Address - Fax:
Practice Address - Street 1:823 AVE SAN PATRICIO
Practice Address - Street 2:LAS LOMAS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921-1311
Practice Address - Country:US
Practice Address - Phone:787-781-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice