Provider Demographics
NPI:1952747545
Name:PISHADENT,LLC
Entity Type:Organization
Organization Name:PISHADENT,LLC
Other - Org Name:PATRICIA IRIZARRI DME
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROLON
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLENDA
Authorized Official - Suffix:
Authorized Official - Credentials:O
Authorized Official - Phone:787-630-8288
Mailing Address - Street 1:JARDINES FAGOT 15
Mailing Address - Street 2:S-1
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-840-3435
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE JARDINES
Practice Address - Street 2:S-1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3547
Practice Address - Country:US
Practice Address - Phone:787-840-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty