Provider Demographics
NPI:1427450659
Name:JORGE VARELA DENTAL OFFICE
Entity type:Organization
Organization Name:JORGE VARELA DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:VARELA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-763-5503
Mailing Address - Street 1:525 TORRE DE PLAZA LAS AMERICAS FDR
Mailing Address - Street 2:SUITE 609
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-8001
Mailing Address - Country:US
Mailing Address - Phone:787-763-5503
Mailing Address - Fax:
Practice Address - Street 1:525 AVE FRANKLIN D ROOSEVELT
Practice Address - Street 2:SUITE 609 TORRE PLAZA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-763-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2329261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental