| San Patricio Dental, Llc | |
|
101 Ave San Patricio Maramar Plaza Suite 1210 Guaynabo PR 00968-2645 | |
| (787) 565-0134 | |
| Not Available |
| Full Name | San Patricio Dental, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 101 Ave San Patricio, Guaynabo, Puerto Rico |
| Authorized Official Name and Position | Anabelle M Mudafort (PRESIDENT) |
| Authorized Official Contact | 7875650134 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Patricio Dental, Llc 101 Ave San Patricio Maramar Plaza Suite 1210 Guaynabo PR 00968-2645 Ph: () - | San Patricio Dental, Llc 101 Ave San Patricio Maramar Plaza Suite 1210 Guaynabo PR 00968-2645 Ph: (787) 565-0134 |
| NPI Number | 1003168675 |
|---|---|
| Provider Enumeration Date | 10/08/2012 |
| Last Update Date | 10/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003168675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 2808 (Puerto Rico) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 2787 (Puerto Rico) | Primary |
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