Provider Demographics
NPI:1952140642
Name:OMAR EL DENTISTA LLC
Entity type:Organization
Organization Name:OMAR EL DENTISTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-370-4346
Mailing Address - Street 1:HC 71 BOX 3278
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9536
Mailing Address - Country:US
Mailing Address - Phone:787-370-4346
Mailing Address - Fax:
Practice Address - Street 1:CARR 152 KM 7.6 BO QUEBRADILLAS
Practice Address - Street 2:SEC LOS LOPEZ
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-370-4346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty