Provider Demographics
NPI:1619363744
Name:NEGMER DENTAL GROUP,LLC
Entity Type:Organization
Organization Name:NEGMER DENTAL GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-518-0660
Mailing Address - Street 1:PO BOX 1291
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-1291
Mailing Address - Country:US
Mailing Address - Phone:787-518-0660
Mailing Address - Fax:787-867-0980
Practice Address - Street 1:60 CALLE GEORGETTI
Practice Address - Street 2:SUITE 1C
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3607
Practice Address - Country:US
Practice Address - Phone:787-751-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18171223G0001X
PR29101223G0001X
PR8921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty