Organization Name: | RG DENTAL PSC |
NPI Number: | 1205207487 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID SOTO (PRESIDENT) |
Mailing Address: | A1 Avenida Agustin Perez Andino Villas De Rio Grande Rio Grande |
State: | PR US |
Postal Code: | 00745 |
Phone Number: | 7878877907 |
Fax Number: | 7878874676 |
NPI Enumeration Date: | 10/13/2015 |
NPI Last Update Date: | 10/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 1946 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |