Provider Demographics
NPI:1063919124
Name:CENTRO DE RECONSTRUCCION ORAL E IMPLANTES
Entity type:Organization
Organization Name:CENTRO DE RECONSTRUCCION ORAL E IMPLANTES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEDROZA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-781-1831
Mailing Address - Street 1:PO BOX 361357
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1357
Mailing Address - Country:US
Mailing Address - Phone:787-781-1831
Mailing Address - Fax:787-781-5030
Practice Address - Street 1:CALLE 1 ESQ 6 URB PARKSIDE COND SAN PATRICIO II
Practice Address - Street 2:SUITE 1
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-781-1831
Practice Address - Fax:787-781-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental