Provider Demographics
NPI:1164293726
Name:DEL PARQUE DENTAL CENTER LLC
Entity Type:Organization
Organization Name:DEL PARQUE DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-664-0935
Mailing Address - Street 1:HC 67 BOX 15090
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 CALLE DEL PARQUE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1968
Practice Address - Country:US
Practice Address - Phone:787-723-8299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty