Basic Information
| Provider Information | |||||||||
| NPI: | 1487861704 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DENTALIA MEDIKA CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800 | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009860800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877763840 | ||||||||
| FaxNumber: | 7872762923 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR 857 0.4 | ||||||||
| Address2: | BO CANOVANILLAS | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877763840 | ||||||||
| FaxNumber: | 7872762923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PIETRI | ||||||||
| AuthorizedOfficialFirstName: | RAFAEL | ||||||||
| AuthorizedOfficialMiddleName: | ORTIZ | ||||||||
| AuthorizedOfficialTitleorPosition: | DUENO | ||||||||
| AuthorizedOfficialTelephone: | 7877763840 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.