Liana I Boada, DMD
Individual provider Active NPI Dentist · San Juan, PR
NPI 1295872406 · NPPES record last updated Aug 6, 2024
Key facts
- NPI
- 1295872406
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1045 (PR)
- Practice address
- 239 Ave Arterial Hostos
Suite 1103
San Juan, PR 00918-1477 - Phone
- (787) 754-7747
- Fax
- (787) 754-7747
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150817001677 | PR | Order and Referring Only - Dentist |
5092020248 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1045 | PR | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kore Group LLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1045 | PR | Yes |
Addresses
Primary practice location
239 Ave Arterial Hostos
Suite 1103
San Juan, PR 00918-1477
Mailing address
239 Ave Arterial Hostos
Suite 1103
San Juan, PR 00918-1477
Phone (787) 754-7747
Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.