Provider Demographics
NPI:1215064605
Name:PUERTO RICO DENTAL CARE
Entity type:Organization
Organization Name:PUERTO RICO DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORTIZ DE LA RENTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-776-0570
Mailing Address - Street 1:PO BOX 8480
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0480
Mailing Address - Country:US
Mailing Address - Phone:787-776-0570
Mailing Address - Fax:787-776-0570
Practice Address - Street 1:VIA MIRTA 3 DS-1
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-776-0570
Practice Address - Fax:787-776-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty