Provider Demographics
NPI:1851494199
Name:MATTEI-MOLINI, JAN ALEXIS (DDS)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:ALEXIS
Last Name:MATTEI-MOLINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1521
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1521
Mailing Address - Country:US
Mailing Address - Phone:787-899-4925
Mailing Address - Fax:
Practice Address - Street 1:#80 CALLE 65 INFANTERIA SUR
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660606211OtherEIN PAULA C SERV DENT CSP