Organization
LASER DENTAL CENTERS,CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLYDE FASICK JULIA MD (DENTITA)
(787) 725-4776
Entity
Organization
Contact information
Practice address
ASHFORD MEDICAL CENTER SUITE 808 # 29, SAN JUAN, PR 00907
(787) 728-4776
(787) 725-4776
Mailing address
PMB 352 # 35 JUAN C BORBON STE 67, GUAYNABO, PR 00969
(787) 725-4776
(787) 725-4776
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/13/2007
Last updated
06/20/2008
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