Provider Demographics
NPI:1154412567
Name:BADILLO, JEANNE MICHELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:MICHELLE
Last Name:BADILLO
Suffix:
Gender:F
Credentials:DMD
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 9132
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9132
Mailing Address - Country:US
Mailing Address - Phone:787-680-7385
Mailing Address - Fax:787-680-7386
Practice Address - Street 1:300 AVE. FELISA RINCON DE GAUTIER
Practice Address - Street 2:LAS VISTAS SHOPPING VILLAGE, SUITE 40
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-680-7385
Practice Address - Fax:787-680-7386
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics