| San Juan Smile Spa, Llc | |
|
374 Calle Rafael Lamar San Juan PR 00918-2117 | |
| (787) 767-7471 | |
| Not Available |
| Full Name | San Juan Smile Spa, Llc |
|---|---|
| Speciality | Dentist |
| Location | 374 Calle Rafael Lamar, San Juan, Puerto Rico |
| Authorized Official Name and Position | Mayra Llado Ortega (PRESIDENT) |
| Authorized Official Contact | 7877677471 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Juan Smile Spa, Llc 374 Calle Rafael Lamar San Juan PR 00918-2117 Ph: (787) 767-7471 | San Juan Smile Spa, Llc 374 Calle Rafael Lamar San Juan PR 00918-2117 Ph: (787) 767-7471 |
| NPI Number | 1841982014 |
|---|---|
| Provider Enumeration Date | 05/24/2023 |
| Last Update Date | 05/24/2023 |
| Medicare PECOS PAC ID | 3476914540 |
|---|---|
| Medicare Enrollment ID | O20230804003367 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841982014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223P0700X | Dentist - Prosthodontics | (* (Not Available)) | Primary |
| Provider Name | Mayra Llado Ortega |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1508991076 PECOS PAC ID: 5193023596 Enrollment ID: I20230804003395 |
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