Provider Demographics
NPI:1992789333
Name:FRONTERA ROURA, ERIC D (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:FRONTERA ROURA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CALLE MARIO BRASCHI
Mailing Address - Street 2:P.O.BOX 89
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2501
Mailing Address - Country:US
Mailing Address - Phone:787-825-1164
Mailing Address - Fax:787-825-3647
Practice Address - Street 1:7 CALLE MARIO BRASCHI
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2501
Practice Address - Country:US
Practice Address - Phone:787-825-1164
Practice Address - Fax:787-825-3647
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice