Provider Demographics
NPI:1093843765
Name:ROCAFORT ORTEGA, GUILLERMO (DDS)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:ROCAFORT ORTEGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367064
Mailing Address - Street 2:136 ZOMESE RIO PIEDES HEIGHTS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-525-6999
Mailing Address - Fax:
Practice Address - Street 1:LIZZIE GRAHAM JR3 LEVITOUN
Practice Address - Street 2:
Practice Address - City:BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-789-1627
Practice Address - Fax:787-789-1627
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice