Provider Demographics
NPI:1871315440
Name:SERVICIOS DENTALES ESPECIALIZADOS, C.S.P.
Entity type:Organization
Organization Name:SERVICIOS DENTALES ESPECIALIZADOS, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTODONCISTA
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH, MS
Authorized Official - Phone:787-731-8424
Mailing Address - Street 1:4 AVE ALEJANDRINO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4712
Mailing Address - Country:US
Mailing Address - Phone:787-731-8424
Mailing Address - Fax:787-790-1859
Practice Address - Street 1:4 AVE ALEJANDRINO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4712
Practice Address - Country:US
Practice Address - Phone:787-731-8424
Practice Address - Fax:787-790-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty