Emergency Dental & Maxilofacial Care CSP

Primary specialty

DentistTaxonomy code 122300000X

License

000591 Issued in PR

Legal business name

EMERGENCY DENTAL & MAXILOFACIAL CARE CSP

Practice address

Ave Sabana Seca
Carr 867 KM 2.2
Toa Baja, PUERTO RICO 00951
UM

Phone

(787) 261-3260

Fax

(787) 261-3260

NPI assigned

Sep 6, 2012

Last updated

Sep 6, 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. Jose M Rodriguez BenitezNPI 1871560938

Title

President

Phone

(787) 261-3260

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jose M Rodriguez Benitez

  • General Practice Physician
  • Caguas, PR
  • NPI 1871560938
  Authorized official Same address or phone

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

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346889600000",
    "number": "1124377031",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "PO BOX 1388",
            "city": "CAGUAS",
            "state": "PUERTO RICO",
            "postal_code": "00726",
            "telephone_number": "787-745-0708",
            "fax_number": "787-747-9300"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "AVE SABANA SECA",
            "address_2": "CARR 867 KM 2.2",
            "city": "TOA BAJA",
            "state": "PUERTO RICO",
            "postal_code": "00951",
            "telephone_number": "787-261-3260",
            "fax_number": "787-261-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY DENTAL & MAXILOFACIAL CARE CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-06",
        "last_updated": "2012-09-06",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ BENITEZ",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-261-3260",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PR",
            "license": "000591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTRO EMERGENCY DENTAL",
            "identifier": "3648",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.