Provider Demographics
NPI:1952056533
Name:MARRERO COLON, LOREINY MARIEL (DMD)
Entity Type:Individual
Prefix:
First Name:LOREINY
Middle Name:MARIEL
Last Name:MARRERO COLON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 CALLE DE DIEGO APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3134
Mailing Address - Country:US
Mailing Address - Phone:939-254-7909
Mailing Address - Fax:
Practice Address - Street 1:CENTRO GRAN CARIBE SUITE 208
Practice Address - Street 2:CARR #2 KM 29.7
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
PR3433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6501442OtherDRIVER LICENSE