Provider Demographics
NPI:1881781516
Name:CENTRO DENTAL PEDIATRICO
Entity type:Organization
Organization Name:CENTRO DENTAL PEDIATRICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIEDALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-860-4088
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:FAJURDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-4088
Mailing Address - Fax:787-863-2441
Practice Address - Street 1:GENERAL VALERO AVENUE
Practice Address - Street 2:311
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-4088
Practice Address - Fax:787-863-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty