Provider Demographics
NPI:1194840637
Name:COLON MEDINA, GILBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:
Last Name:COLON MEDINA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GILBERTO
Other - Middle Name:
Other - Last Name:COLON MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:628 PEDRO VELAZQUEZ
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624
Mailing Address - Country:US
Mailing Address - Phone:787-836-3333
Mailing Address - Fax:787-836-1729
Practice Address - Street 1:628 PEDRO VELAZQUEZ
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-836-3333
Practice Address - Fax:787-836-1729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice