Provider Demographics
NPI:1427432491
Name:GUAYNABO ORTHODONTICS C.P.
Entity type:Organization
Organization Name:GUAYNABO ORTHODONTICS C.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENDEZ-VILLAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-720-0820
Mailing Address - Street 1:57 AVE ESMERALDA
Mailing Address - Street 2:URB MUNOZ RIVERA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4429
Mailing Address - Country:US
Mailing Address - Phone:787-720-0820
Mailing Address - Fax:787-720-1409
Practice Address - Street 1:57 AVE ESMERALDA
Practice Address - Street 2:URB MUNOZ RIVERA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4429
Practice Address - Country:US
Practice Address - Phone:787-720-0820
Practice Address - Fax:787-720-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty