# GRUPO DENTAL PEDIATRICO SAN JUAN CSP

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

## Provider details

- **NPI number:** 1700299104
- **Authorized official:** MRS. YILDA M RIVERA I DMD (PRESIDENT)
- **Authorized official phone:** (787) 753-1475

## Contact information

- **Practice address:** 576 AVE CESAR GONZALEZ SUITE 307, GRUPO DENTAL PEDIATRICO DORAL BANK CENTER, SAN JUAN, PR 00918-0000
- **Practice address phone:** (787) 753-1405
- **Practice address fax:** (787) 753-1475
- **Mailing address:** 576 AVE CESAR GONZALEZ SUITE 307, GRUPO DENTAL PEDIATRICO DORAL BANK CENTER, SAN JUAN, PR 00918-0000
- **Mailing address phone:** (787) 753-1405
- **Mailing address fax:** (787) 753-1475

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2767 | PR | — |
| 1223P0221X | Pediatric Dentistry | 2472 | PR | — |
| 1223P0221X | Pediatric Dentistry | 2841 | PR | — |
| 1223P0221X | Pediatric Dentistry | 618 | PR | Yes |

## Other

- **Enumeration date:** 06/04/2014
- **Last updated:** 06/04/2014