Provider Demographics
NPI:1144300203
Name:GRUPO DE ODONTOLOGIA COSMETICA Y ORTODONCIA
Entity type:Organization
Organization Name:GRUPO DE ODONTOLOGIA COSMETICA Y ORTODONCIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-835-4014
Mailing Address - Street 1:PO BOX 560537
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-0537
Mailing Address - Country:US
Mailing Address - Phone:787-835-4014
Mailing Address - Fax:787-835-4014
Practice Address - Street 1:254 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-1717
Practice Address - Country:US
Practice Address - Phone:787-835-4014
Practice Address - Fax:787-835-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty