Provider Demographics
NPI:1538715404
Name:LRC ESTHETIC DENTAL CARE
Entity type:Organization
Organization Name:LRC ESTHETIC DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAM
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:RIVERA CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-773-0123
Mailing Address - Street 1:PO BOX 6063
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6063
Mailing Address - Country:US
Mailing Address - Phone:787-773-0123
Mailing Address - Fax:
Practice Address - Street 1:576 CALLE CESAR GONZALEZ STE 301
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3757
Practice Address - Country:US
Practice Address - Phone:787-773-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental