# SAN PATRICIO DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003168675
- **Authorized official:** DR. ANABELLE M MUDAFORT DMD (PRESIDENT)
- **Authorized official phone:** (787) 565-0134

## Contact information

- **Practice address:** 101 AVE SAN PATRICIO, MARAMAR PLAZA SUITE 1210, GUAYNABO, PR 00968-2645
- **Practice address phone:** (787) 565-0134
- **Mailing address:** 101 AVE SAN PATRICIO, MARAMAR PLAZA SUITE 1210, GUAYNABO, PR 00968-2645

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 2808 | PR | — |
| 1223P0221X | Pediatric Dentistry | 2787 | PR | Yes |

## Other

- **Enumeration date:** 10/08/2012
- **Last updated:** 10/08/2012