Provider Demographics
NPI:1518098110
Name:RODRIGUEZ PONSA, GLORIA MILAGROS (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:MILAGROS
Last Name:RODRIGUEZ PONSA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:MILAGROS
Other - Last Name:RODRGUEZ PONSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:800 CALLE VESTA
Mailing Address - Street 2:URB. DOS PINOS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-2342
Mailing Address - Country:US
Mailing Address - Phone:787-292-9443
Mailing Address - Fax:787-786-4133
Practice Address - Street 1:BAYAMON OESTE SHOPPING CENTER CARR. #2
Practice Address - Street 2:HATO TEJAS SUITE #12
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-4133
Practice Address - Fax:787-786-4133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry