San Patricio Dental, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2787 Issued in PR

Legal business name

SAN PATRICIO DENTAL, LLC

Practice address

101 Ave San Patricio
Maramar Plaza Suite 1210
Guaynabo, PR 00968-2645

Phone

(787) 565-0134

NPI assigned

Oct 8, 2012

Last updated

Oct 8, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anabelle M Mudafort, DMD

Title

President

Phone

(787) 565-0134

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1003168675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 AVE SAN PATRICIO",
            "address_2": "MARAMAR PLAZA SUITE 1210",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "009682645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 AVE SAN PATRICIO",
            "address_2": "MARAMAR PLAZA SUITE 1210",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "009682645",
            "telephone_number": "787-565-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PATRICIO DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "MUDAFORT",
        "authorized_official_first_name": "ANABELLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-565-0134",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "PR",
            "license": "2808",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PR",
            "license": "2787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Salud Quiropractica, PSC
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• Anuar Sammy Odeh, DMD
• San Juan Capestrano Hospital, Inc.
• San Juan City Hospital
• San Patricio Gastroenterology, PSC
• San Patricio MRI & CT Center, P.S.C. (San Patricio Medflix)
• San Patricio Nuclear Medicine, PSC
• San Patricio Physical Rehabilitation Center PSC
• San Pedro Pharmacy Corp

• Pediatric Dentistry in Guaynabo, PR
• Providers in Guaynabo, PR by specialty
• Pediatric Dentistry in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.