Provider Demographics
NPI:1902874712
Name:DENTO-LAB, INC
Entity Type:Organization
Organization Name:DENTO-LAB, INC
Other - Org Name:LABORATORIO CLINICO LAS LOMAS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT-DENTO-LAB, INC
Authorized Official - Prefix:
Authorized Official - First Name:FREDICKSON
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-892-8585
Mailing Address - Street 1:HC 03 BOX 25708
Mailing Address - Street 2:SAN GERMAN MEDICAL PLAZA
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9339
Mailing Address - Country:US
Mailing Address - Phone:787-892-8585
Mailing Address - Fax:787-892-8585
Practice Address - Street 1:CARR #2, RM 174, SUITE 101
Practice Address - Street 2:SAN GERMAN MEDICAL PLAZA
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-9339
Practice Address - Country:US
Practice Address - Phone:787-892-8585
Practice Address - Fax:787-892-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31469Medicare ID - Type Unspecified
PR31469Medicare ID - Type Unspecified