Provider Demographics
NPI:1194059261
Name:WEST COAST SMILES PSC
Entity type:Organization
Organization Name:WEST COAST SMILES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-891-3430
Mailing Address - Street 1:PO BOX 605-703
Mailing Address - Street 2:PMB#314
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:787-891-3430
Mailing Address - Fax:787-891-6294
Practice Address - Street 1:107 RD. 2.8 KM. 2053 BUILDING
Practice Address - Street 2:SUITE #1
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-3430
Practice Address - Fax:787-891-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2652122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty