Provider Demographics
NPI:1508900606
Name:RIOS ROSA, JULIO DAVID (DENTISTA)
Entity type:Individual
Prefix:MR
First Name:JULIO
Middle Name:DAVID
Last Name:RIOS ROSA
Suffix:
Gender:M
Credentials:DENTISTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 7583
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:787-872-3560
Mailing Address - Fax:787-872-3560
Practice Address - Street 1:AVE. JUAN HERNANDEZ ORTIZ
Practice Address - Street 2:CENTRO COMERCIAL COOP OFIC 205
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-872-3560
Practice Address - Fax:787-872-3560
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice