Organization
JARUCO DENTAL SERVICES CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVELISSE DOMINGUEZ REVERON M.D (PRESIDENT)
(787) 866-3631
Entity
Organization
Contact information
Practice address
24 CALLE SANTIAGO PALMER SUR, GUAYAMA, PR 00784
(787) 866-3631
(787) 866-8690
Mailing address
24 CALLE SANTIAGO PALMER SUR, GUAYAMA, PR 00784
(787) 866-3631
(787) 866-8690
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/26/2015
Last updated
05/26/2015
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