Provider Demographics
NPI:1952564643
Name:DR.OSCAR MUNIZ LUCIANO MAXILLOFACIAL SURGERY PSC
Entity type:Organization
Organization Name:DR.OSCAR MUNIZ LUCIANO MAXILLOFACIAL SURGERY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:1787-833-1215
Mailing Address - Street 1:27 CALLE DR NELSON PEREA
Mailing Address - Street 2:DOCTORS CENTER BUILDING SUITE 206
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4949
Mailing Address - Country:US
Mailing Address - Phone:178-783-3121
Mailing Address - Fax:178-726-5058
Practice Address - Street 1:27 CALLE DR NELSON PEREA
Practice Address - Street 2:DOCTORS CENTER BUILDING SUITE 206
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4949
Practice Address - Country:US
Practice Address - Phone:178-783-3121
Practice Address - Fax:178-726-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PROTH000Medicare UPIN