Provider Demographics
NPI:1578602447
Name:PONCE DENTAL GROUP
Entity Type:Organization
Organization Name:PONCE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUNOZ-BUSQUETS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-840-3435
Mailing Address - Street 1:S1 CALLE 15
Mailing Address - Street 2:JARDINES FAGOT
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4048
Mailing Address - Country:US
Mailing Address - Phone:787-840-3435
Mailing Address - Fax:787-840-3090
Practice Address - Street 1:S1 CALLE 15
Practice Address - Street 2:JARDINES FAGOT
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4048
Practice Address - Country:US
Practice Address - Phone:787-840-3435
Practice Address - Fax:787-840-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty