Provider Demographics
NPI:1942365945
Name:BURGOS MERCADO, LUIS ARNALDO (DMD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ARNALDO
Last Name:BURGOS MERCADO
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:BOX 9070
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-9070
Mailing Address - Country:US
Mailing Address - Phone:787-843-2131
Mailing Address - Fax:
Practice Address - Street 1:CONCORDIA STREET #8129
Practice Address - Street 2:COND CONCORDIA SUITE #504
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1549
Practice Address - Country:US
Practice Address - Phone:787-843-6969
Practice Address - Fax:787-843-6969
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery