Provider Demographics
NPI:1023349537
Name:CONSOLIDATED DENTAL OFFICE PSC
Entity type:Organization
Organization Name:CONSOLIDATED DENTAL OFFICE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-743-2128
Mailing Address - Street 1:CONSOLIDATED MEDICAL PLAZA ,AVE. GAUTIER BENITEZ
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-743-2128
Mailing Address - Fax:787-743-2128
Practice Address - Street 1:CONSOLIDATED MEDICAL PLAZA ,AVE. GAUTIER BENITEZ
Practice Address - Street 2:SUITE 202
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-2128
Practice Address - Fax:787-743-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1889261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental