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Organization

GRUPO DENTAL PEDIATRICO SAN JUAN CSP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. YILDA M RIVERA I DMD (PRESIDENT)
(787) 753-1475
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
2767
PR
1223P0221X
Pediatric Dentistry
2472
PR
1223P0221X
Pediatric Dentistry
2841
PR
1223P0221X
Pediatric Dentistry
Primary
618
PR

Other

Enumeration date
06/04/2014
Last updated
06/04/2014
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