Provider Demographics
NPI:1144413535
Name:ISABELA DENTAL CLINIC
Entity type:Organization
Organization Name:ISABELA DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIOS ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-872-3560
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1583
Mailing Address - Country:US
Mailing Address - Phone:787-872-3560
Mailing Address - Fax:787-872-3560
Practice Address - Street 1:AVE. JUAN HERNANDEZ ORTIZ
Practice Address - Street 2:CENTRO COMERCIAL COOP OFIC 205
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-872-3560
Practice Address - Fax:787-872-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1156261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1156OtherLIC