Provider Demographics
NPI:1447667506
Name:RVP DENTAL MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:RVP DENTAL MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YINAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-645-4748
Mailing Address - Street 1:574 HACIENDA SAN JOSE
Mailing Address - Street 2:VIA DEL GUAYABAL
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3064
Mailing Address - Country:US
Mailing Address - Phone:787-645-4748
Mailing Address - Fax:
Practice Address - Street 1:229 CALLE DUARTE
Practice Address - Street 2:FLORAL PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3631
Practice Address - Country:US
Practice Address - Phone:787-945-5077
Practice Address - Fax:787-945-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2759261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental