Provider Demographics
NPI:1871642256
Name:IZQUIERDO, GINETTE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:GINETTE
Middle Name:MARIE
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CALLE POMARROSA
Mailing Address - Street 2:LADERAS DE SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9330
Mailing Address - Country:US
Mailing Address - Phone:787-474-0762
Mailing Address - Fax:
Practice Address - Street 1:81 AVE ESMERALDA
Practice Address - Street 2:MUNOZ RIVERA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4429
Practice Address - Country:US
Practice Address - Phone:787-720-1323
Practice Address - Fax:787-720-8913
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist