Provider Demographics
NPI:1336224856
Name:BERDIEL, ROBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:BERDIEL
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 1:239 AVE. ARTERIAL HOSTOS
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-296-4000
Mailing Address - Fax:787-296-3064
Practice Address - Street 1:239 AVE. ARTERIAL HOSTOS
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-296-4000
Practice Address - Fax:787-296-3064
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice