NPI: 1710166186 · SAN JUAN, PR 00909 · Dental Clinic/Center · NPI assigned 11/01/2007
| Authorized Official | RIVERA, ELISA (DENTIST) |
| NPI Enumeration Date | 11/01/2007 |
Other providers sharing the same authorized official: RIVERA, ELISA
| Provider | City | State | Total Paid |
|---|---|---|---|
| DENTAL GALLERY PSC | SAN JUAN | PR | $113K |
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 25 | $362.75 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1999 | 25 | 25 | $362.75 |