Provider Demographics
NPI:1487756904
Name:DE LAOSA, LILIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:
Last Name:DE LAOSA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LILIAN
Other - Middle Name:
Other - Last Name:DE LAOSA VAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:F5 CALLE LA CASA BLANCA
Mailing Address - Street 2:PASEO SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6508
Mailing Address - Country:US
Mailing Address - Phone:787-761-3523
Mailing Address - Fax:787-259-7514
Practice Address - Street 1:201 AVE DE DIEGO STE 205
Practice Address - Street 2:PLAZA SAN FRANCISCO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5815
Practice Address - Country:US
Practice Address - Phone:787-764-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice