Provider Demographics
NPI:1750650032
Name:BARCELONETA DENTAL GROUP
Entity Type:Organization
Organization Name:BARCELONETA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-846-0331
Mailing Address - Street 1:PO BOX 3431
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3431
Mailing Address - Country:US
Mailing Address - Phone:787-846-0331
Mailing Address - Fax:787-846-0331
Practice Address - Street 1:1 CALLE TOMAS DAVILA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2798
Practice Address - Country:US
Practice Address - Phone:787-846-0331
Practice Address - Fax:787-846-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty