Provider Demographics
NPI:1740285717
Name:VERA, MAYRA (DMD)
Entity type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:
Last Name:VERA
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:PO BOX 1892
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1892
Mailing Address - Country:US
Mailing Address - Phone:787-762-0069
Mailing Address - Fax:787-762-1822
Practice Address - Street 1:FIDALGO DIAZ AVE.
Practice Address - Street 2:DL-4 VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-762-0069
Practice Address - Fax:787-762-1822
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR041639OtherLA CRUZ AZUL DE PR
PR206661OtherPREFERRED HEALTH PLAN
PR6280051OtherHUMANA DE PR
PR41441VEOtherTRIPLE-S, INC.
PR2448OtherFIRST MEDICAL