Provider Demographics
NPI:1568864973
Name:ORAL REHAB SPECIALISTS, INC.
Entity type:Organization
Organization Name:ORAL REHAB SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:FADHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-746-0895
Mailing Address - Street 1:50 LUIS MUNOZ MARIN AVE., SUITE 206
Mailing Address - Street 2:QUADRANGLE MEDICAL CENTER
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-746-0895
Mailing Address - Fax:787-746-0895
Practice Address - Street 1:50 LUIS MUNOZ MARIN AVE., SUITE 206
Practice Address - Street 2:QUADRANGLE MEDICAL CENTER
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-0895
Practice Address - Fax:787-746-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1685261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental