| Organization Name: | SAN PATRICIO DENTAL, LLC |
| NPI Number: | 1003168675 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANABELLE M MUDAFORT (PRESIDENT) |
| Mailing Address: | 101 Ave San Patricio Maramar Plaza Suite 1210 Guaynabo |
| State: | PR US |
| Postal Code: | 009682645 |
| Phone Number: | 7875650134 |
| Fax Number: | |
| NPI Enumeration Date: | 10/08/2012 |
| NPI Last Update Date: | 10/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223E0200X |
| License Number: | 2808 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Endodontics |
| Taxonomy Definition: | The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |