Provider Demographics
NPI:1831631951
Name:CENTRO DENTAL CITY VIEW PLAZA, PSC
Entity type:Organization
Organization Name:CENTRO DENTAL CITY VIEW PLAZA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTAELLA HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-620-2500
Mailing Address - Street 1:48 CITY VIEW PLAZA
Mailing Address - Street 2:SUITE 415
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-620-2500
Mailing Address - Fax:787-620-2505
Practice Address - Street 1:48 CARR 165 # KM 1/2
Practice Address - Street 2:SUITE 415
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-8031
Practice Address - Country:US
Practice Address - Phone:787-620-2500
Practice Address - Fax:787-620-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty