Basic Information
| Provider Information | |||||||||
| NPI: | 1164929063 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEP APNEA DENTAL SOLUTIONS OF PUERTO RICO PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 AVE PEDRO ALBIZU CAMPOS STE 111 | ||||||||
| Address2: | |||||||||
| City: | CABO ROJO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006233339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878512365 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8118 CALLE CONCORDIA | ||||||||
| Address2: | EDIF. GALERIA PROFESIONAL; SUITE 107 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878512365 | ||||||||
| FaxNumber: | 7878513458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | ROSA | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 7878515620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SLEEP APNEA DENTAL SOLUTIONS OF PUERTO RICO PSC | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.