| Perio Del Sur LLC | |
|
909 Ave Tito Castro Ste 810 Ponce PR 00716-4725 | |
| (787) 219-9032 | |
| Not Available |
| Full Name | Perio Del Sur LLC |
|---|---|
| Speciality | Dentist |
| Location | 909 Ave Tito Castro Ste 810, Ponce, Puerto Rico |
| Authorized Official Name and Position | Diego E Rodes (PRESIDENT) |
| Authorized Official Contact | 7872199032 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Perio Del Sur LLC Po Box 3171 Mayaguez PR 00681-3171 Ph: (787) 219-9032 | Perio Del Sur LLC 909 Ave Tito Castro Ste 810 Ponce PR 00716-4725 Ph: (787) 219-9032 |
| NPI Number | 1689407785 |
|---|---|
| Provider Enumeration Date | 08/23/2024 |
| Last Update Date | 08/23/2024 |
| Certification Date | 08/23/2024 |
| Medicare PECOS PAC ID | 1951883818 |
|---|---|
| Medicare Enrollment ID | O20260302000435 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689407785 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | () | Secondary |
| 1223P0300X | Dentist - Periodontics | () | Primary |
| Provider Name | Diego E Rodes |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1366176810 PECOS PAC ID: 5597247452 Enrollment ID: I20260309001759 |
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