Provider Demographics
NPI:1871551689
Name:DESA-CINTRON, RICARDO JOSE (DMD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:JOSE
Last Name:DESA-CINTRON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3994
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3994
Mailing Address - Country:US
Mailing Address - Phone:787-891-5169
Mailing Address - Fax:787-891-5169
Practice Address - Street 1:CARR #2 KM 122 5
Practice Address - Street 2:BO CAIMITAL ALTO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-5169
Practice Address - Fax:787-891-5169
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist