Provider Demographics
NPI:1831903467
Name:DELTA DENTAL OF PUERTO RICO INC
Entity type:Organization
Organization Name:DELTA DENTAL OF PUERTO RICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-260-6993
Mailing Address - Street 1:METRO OFFICE PARK
Mailing Address - Street 2:14 CALLE 2 SUITE 200
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-1735
Mailing Address - Country:US
Mailing Address - Phone:939-205-3300
Mailing Address - Fax:
Practice Address - Street 1:METRO OFFICE PARK
Practice Address - Street 2:14 CALLE 2 SUITE 200
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1735
Practice Address - Country:US
Practice Address - Phone:939-205-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization