Provider Demographics
NPI:1346957396
Name:CUPEY DENTAL GALLERY LLC
Entity Type:Organization
Organization Name:CUPEY DENTAL GALLERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
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:787-664-0935
Mailing Address - Fax:
Practice Address - Street 1:AVE. SAN CLAUDIO 390
Practice Address - Street 2:URB. SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-0092
Practice Address - Country:US
Practice Address - Phone:787-748-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental