Provider Demographics
NPI:1528618410
Name:ASHFORD ORAL & MAXILLOFACIAL SURGERY LLC
Entity type:Organization
Organization Name:ASHFORD ORAL & MAXILLOFACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FUENTES ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-403-3587
Mailing Address - Street 1:PALMAS PLANTATION, PALMAS DEL MAR
Mailing Address - Street 2:51
Mailing Address - City:HUMACAO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00791
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 CALLE WASHINGTON STE 502-503
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-403-3587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty