Provider Demographics
NPI:1063925758
Name:ASHFORD PERIODONTICS AND IMPLANTS PSC
Entity type:Organization
Organization Name:ASHFORD PERIODONTICS AND IMPLANTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-403-6228
Mailing Address - Street 1:100 CALLE DEL MUELLE
Mailing Address - Street 2:CAPITOLIO PLAZA APT 2204
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901
Mailing Address - Country:US
Mailing Address - Phone:787-403-6228
Mailing Address - Fax:
Practice Address - Street 1:29 CALLE WASHINGTON STE 709
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1503
Practice Address - Country:US
Practice Address - Phone:787-400-3622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0031561223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty