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Organization
SAN PATRICIO DENTAL, LLC
Active
Organization
SAN PATRICIO DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANABELLE M MUDAFORT DMD (PRESIDENT)
(787) 565-0134
Entity
Organization
Contact information
Practice address
101 AVE SAN PATRICIO, MARAMAR PLAZA SUITE 1210, GUAYNABO, PR 00968-2645
(787) 565-0134
Mailing address
101 AVE SAN PATRICIO, MARAMAR PLAZA SUITE 1210, GUAYNABO, PR 00968-2645
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
2808
PR
1223P0221X
Pediatric Dentistry
Primary
2787
PR
Other
Enumeration date
10/08/2012
Last updated
10/08/2012
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