# SAN JUAN DENTAL CENTER LLC

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

## Provider details

- **NPI number:** 1083198576
- **Authorized official:** ROSA MARIA RODRIGUEZ DMD (DOCTOR)
- **Authorized official phone:** (787) 645-0089

## Contact information

- **Practice address:** 456 CALLE CESAR GONZALEZ, SAN JUAN, PR 00918-2628
- **Practice address phone:** (787) 645-0089
- **Mailing address:** 456 CALLE CESAR GONZALEZ, SAN JUAN, PR 00918-2628
- **Mailing address phone:** (787) 645-0089

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2018
- **Last updated:** 09/20/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 582837989 | — | PR |