Provider Demographics
NPI:1699933606
Name:SERVICIOS DE ENDODONCIA DEL SUR
Entity type:Organization
Organization Name:SERVICIOS DE ENDODONCIA DEL SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARHIMAZDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-866-6406
Mailing Address - Street 1:PO BOX 1499
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1499
Mailing Address - Country:US
Mailing Address - Phone:787-866-6406
Mailing Address - Fax:787-864-0189
Practice Address - Street 1:128 CALLE ASHFORD S STE 204
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-5411
Practice Address - Country:US
Practice Address - Phone:787-866-6406
Practice Address - Fax:787-864-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2315261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center