Provider Demographics
NPI:1548694508
Name:ADVANCEDORTHODONTICS & DENTOFACIAL ORTHOPEDICS, INC.
Entity type:Organization
Organization Name:ADVANCEDORTHODONTICS & DENTOFACIAL ORTHOPEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-756-5911
Mailing Address - Street 1:CLINICA LAS AMERICAS
Mailing Address - Street 2:#400 F.D. ROOSEVELT AVE. SUITE 504
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2103
Mailing Address - Country:US
Mailing Address - Phone:787-756-5911
Mailing Address - Fax:787-751-7338
Practice Address - Street 1:CLINICA LAS AMERICAS
Practice Address - Street 2:#400 F.D. ROOSEVELT AVE. SUITE 504
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-756-5911
Practice Address - Fax:787-751-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2454261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicare PIN