Provider Demographics
NPI:1427270883
Name:CENTRO DE ORTODONCIA, INC
Entity type:Organization
Organization Name:CENTRO DE ORTODONCIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-891-1338
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0605
Mailing Address - Country:US
Mailing Address - Phone:787-891-1338
Mailing Address - Fax:787-891-2266
Practice Address - Street 1:AVE PEDRO ALBIZU CAMPOS #171
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0603
Practice Address - Country:US
Practice Address - Phone:787-891-1338
Practice Address - Fax:787-891-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherPATRONAL SS