Provider Demographics
NPI:1679565154
Name:IRIZARRY, MILTON (DMD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:IRIZARRY
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 1:925 AVE DE DIEGO
Mailing Address - Street 2:LA RIVIERA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2503
Mailing Address - Country:US
Mailing Address - Phone:787-273-0815
Mailing Address - Fax:787-277-0060
Practice Address - Street 1:925 AVE DE DIEGO
Practice Address - Street 2:LA RIVIERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2503
Practice Address - Country:US
Practice Address - Phone:787-273-0815
Practice Address - Fax:787-277-0060
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice