Provider Demographics
NPI:1376897892
Name:CMR DENTAL GROUP, P.S.C.
Entity Type:Organization
Organization Name:CMR DENTAL GROUP, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MYRIAM
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-756-8491
Mailing Address - Street 1:AVE. ESMERALDA #6 URB. PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4280
Mailing Address - Country:US
Mailing Address - Phone:787-756-8491
Mailing Address - Fax:
Practice Address - Street 1:AVE. ESMERALDA #6 URB. PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4280
Practice Address - Country:US
Practice Address - Phone:787-756-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1312261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental