Provider Demographics
NPI:1215925326
Name:DE MARI-PRATS, JOSE LEOPO IDO (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LEOPO IDO
Last Name:DE MARI-PRATS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:844 CALLE HOSTOS
Mailing Address - Street 2:URB HYDE PARK
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4278
Mailing Address - Country:US
Mailing Address - Phone:787-767-5435
Mailing Address - Fax:787-766-2102
Practice Address - Street 1:844 CALLE HOSTOS
Practice Address - Street 2:URB HYDE PARK
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00927-4278
Practice Address - Country:US
Practice Address - Phone:787-767-5435
Practice Address - Fax:787-766-2102
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR0695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist