Provider Demographics
NPI:1629041256
Name:BONILLA ARGUDO, JORGE I (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:I
Last Name:BONILLA ARGUDO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MENDEZ VIGO W
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-3847
Mailing Address - Country:US
Mailing Address - Phone:787-834-5680
Mailing Address - Fax:
Practice Address - Street 1:101 MENDEZ VIGO W
Practice Address - Street 2:SUITE 107
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3847
Practice Address - Country:US
Practice Address - Phone:787-834-5680
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice