Provider Demographics
NPI:1427494723
Name:DENTAL ESTHETIC SOLUTIONS
Entity type:Organization
Organization Name:DENTAL ESTHETIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-777-1163
Mailing Address - Street 1:ROOSEVELT AVE. CLINICA LAS AMERICAS
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-777-1163
Mailing Address - Fax:787-777-1164
Practice Address - Street 1:ROOSEVELT AVE. CLINICA LAS AMERICAS
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-777-1163
Practice Address - Fax:787-777-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28851223G0001X
PR28351223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty