# IDENTAL CENTER, PSC

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

## Provider details

- **NPI number:** 1760785802
- **Authorized official:** MARIA I GOMEZ (MANAGER)
- **Authorized official phone:** (787) 266-3140

## Contact information

- **Practice address:** A5 STREET 1, URBANIZACION VILLA HILDA, YABUCOA, PR 00767
- **Practice address phone:** (787) 266-3140
- **Mailing address:** PO BOX 1198, LAS PIEDRAS, PR 00771-1198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 2663 | PR | Yes |

## Other

- **Enumeration date:** 12/13/2010
- **Last updated:** 12/13/2010