Provider Demographics
NPI:1487105797
Name:D.P. HEALTH GROUP CORP
Entity type:Organization
Organization Name:D.P. HEALTH GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DISLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-938-8912
Mailing Address - Street 1:185 CALLE DELBREY
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-2007
Mailing Address - Country:US
Mailing Address - Phone:787-938-8912
Mailing Address - Fax:787-725-1703
Practice Address - Street 1:185 CALLE DELBREY
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-2007
Practice Address - Country:US
Practice Address - Phone:787-938-8912
Practice Address - Fax:787-725-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1978261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental