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Organization
BOUTIQUE DENTAL
Active
Organization
BOUTIQUE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA RIVERA CRUZ (SECRETARY)
(787) 428-6363
Entity
Organization
Contact information
Practice address
URB ROYAL TOWN AVE LAS CUMBRES A20, BAYAMON, PR 00956
(787) 428-6363
(787) 799-5052
Mailing address
URB ROYAL TOWN AVE LAS CUMBRES A20, BAYAMON, PR 00956
(787) 428-6363
(787) 799-5052
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
Other
Enumeration date
03/13/2020
Last updated
03/13/2020
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