Provider Demographics
NPI:1477273589
Name:BORINQUEN PERIODONTICS & DENTAL IMPLANTS PLLC
Entity Type:Organization
Organization Name:BORINQUEN PERIODONTICS & DENTAL IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, FAGD
Authorized Official - Phone:904-305-8555
Mailing Address - Street 1:218 SCOTLAND YARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5914
Mailing Address - Country:US
Mailing Address - Phone:904-305-8555
Mailing Address - Fax:
Practice Address - Street 1:14866 OLD SAINT AUGUSTINE RD STE 111
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2611
Practice Address - Country:US
Practice Address - Phone:904-342-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental