Provider Demographics
NPI:1356336176
Name:VINCENTY, MARGARITA M I (DMD)
Entity type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:M
Last Name:VINCENTY
Suffix:I
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARGARITA
Other - Middle Name:M
Other - Last Name:VINCENTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4803 CALLE SIRIO
Mailing Address - Street 2:URB STARLIGHT
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1462
Mailing Address - Country:US
Mailing Address - Phone:787-840-4747
Mailing Address - Fax:
Practice Address - Street 1:4803 CALLE SIRIO
Practice Address - Street 2:URB STARLIGHT
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1462
Practice Address - Country:US
Practice Address - Phone:787-840-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12OtherDENTIST