Provider Demographics
NPI:1780416362
Name:MCR DENTAL SERVICES LLC
Entity type:Organization
Organization Name:MCR DENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR & DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO ROLDOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-255-3486
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622
Mailing Address - Country:US
Mailing Address - Phone:787-255-3486
Mailing Address - Fax:
Practice Address - Street 1:CARR. 308 KM. 0.0, INT. CARR. 103, EDIF. #833
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-255-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty