# DENTO-PED, CSP

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

## Provider details

- **NPI number:** 1740258557
- **Authorized official:** SELMA BASORA DMD (PRESIDENT/SECRETARY)
- **Authorized official phone:** (787) 892-0585

## Contact information

- **Practice address:** HC 1 BOX 25708, SAN GERMAN, PR 00683-9806
- **Practice address phone:** (787) 892-0585
- **Practice address fax:** (787) 892-0585
- **Mailing address:** HC 1 BOX 25708, SAN GERMAN, PR 00683-9806
- **Mailing address phone:** (787) 892-0585
- **Mailing address fax:** (787) 892-0585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 2510 | PR | Yes |

## Other

- **Enumeration date:** 03/08/2006
- **Last updated:** 08/22/2020