Provider Demographics
NPI:1285935239
Name:ECG DENTISTRY P.S.C.
Entity type:Organization
Organization Name:ECG DENTISTRY P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:COLON
Authorized Official - Last Name:GOTAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-276-5450
Mailing Address - Street 1:STATE RD 3 KM 8.40 BARRIO MARTIN GONZALES
Mailing Address - Street 2:#107 PASEO DEL PRADO SHOPPING CENTER
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-276-5450
Mailing Address - Fax:787-276-5452
Practice Address - Street 1:STATE RD 3 KM 8.40 BARRIO MARTIN GONZALES
Practice Address - Street 2:#107 PASEO DEL PRADO SHOPPING CENTER
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-276-5450
Practice Address - Fax:787-276-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty