Organization
IDENTAL CENTER, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA I GOMEZ (MANAGER)
(787) 266-3140
Entity
Organization
Contact information
Practice address
A5 STREET 1, URBANIZACION VILLA HILDA, YABUCOA, PR 00767
(787) 266-3140
Mailing address
PO BOX 1198, LAS PIEDRAS, PR 00771-1198
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2673
PR
Other
Enumeration date
12/13/2010
Last updated
12/13/2010
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