Provider Demographics
NPI:1871042325
Name:DENTISTAS MISIONEROS DE PR (DMDPR)
Entity Type:Organization
Organization Name:DENTISTAS MISIONEROS DE PR (DMDPR)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-852-8255
Mailing Address - Street 1:58 CALLE MANUEL CRUZ
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3627
Mailing Address - Country:US
Mailing Address - Phone:787-852-1579
Mailing Address - Fax:787-852-8255
Practice Address - Street 1:CALLE WILLIAM FONT FINAL
Practice Address - Street 2:CLINICA DENTAL CDT CULEBRA
Practice Address - City:CULEBRA
Practice Address - State:PR
Practice Address - Zip Code:00775
Practice Address - Country:US
Practice Address - Phone:787-742-0001
Practice Address - Fax:787-742-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty