Provider Demographics
NPI:1881796910
Name:MACHICOTE, JORGE L (DMD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:MACHICOTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14306
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00916-4306
Mailing Address - Country:US
Mailing Address - Phone:787-726-4988
Mailing Address - Fax:787-726-4988
Practice Address - Street 1:2062 BORINOUEN AVE BARRIO OBRERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915
Practice Address - Country:US
Practice Address - Phone:787-726-4988
Practice Address - Fax:787-726-4988
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice