Provider Demographics
NPI:1538411285
Name:CENTRO DE PERIODONCIA E IMPLANTOLOGIA PAVIA
Entity type:Organization
Organization Name:CENTRO DE PERIODONCIA E IMPLANTOLOGIA PAVIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:EMILLE
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-721-4646
Mailing Address - Street 1:1449 CALLE AMERICO SALAS STE 202
Mailing Address - Street 2:1449 AMERICO SALAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2101
Mailing Address - Country:US
Mailing Address - Phone:787-720-4646
Mailing Address - Fax:787-721-4500
Practice Address - Street 1:1449 CALLE AMERICO SALAS STE 202
Practice Address - Street 2:1449 AMERICO SALAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2101
Practice Address - Country:US
Practice Address - Phone:787-720-4646
Practice Address - Fax:787-721-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty