Provider Demographics
NPI:1306642137
Name:DENTIQUE STUDIO LLC
Entity type:Organization
Organization Name:DENTIQUE STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIVERA ESPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:939-545-5522
Mailing Address - Street 1:1225 CONDOMINIO LA ALBORADA CARR 2 APT 232
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URB LEVITOWN LAKES
Practice Address - Street 2:FF15 CALLE LUIS PALES MATOS
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-2770
Practice Address - Country:US
Practice Address - Phone:939-545-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty