Provider Demographics
NPI:1467879890
Name:BURGOS, JOSE RAMON (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAMON
Last Name:BURGOS
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:PO BOX 10818
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0818
Mailing Address - Country:US
Mailing Address - Phone:787-745-6220
Mailing Address - Fax:
Practice Address - Street 1:PLAZA DEL CARMEN MALL SUITE 22
Practice Address - Street 2:PR-172
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058228-011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics