Provider Demographics
NPI:1912975723
Name:DENTO-MEDICS, CSP
Entity Type:Organization
Organization Name:DENTO-MEDICS, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:FREDICKSON
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-892-0585
Mailing Address - Street 1:HC 1 BOX 25708
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9806
Mailing Address - Country:US
Mailing Address - Phone:787-892-0585
Mailing Address - Fax:787-892-0585
Practice Address - Street 1:HC 1 BOX 25708
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-9806
Practice Address - Country:US
Practice Address - Phone:787-892-0585
Practice Address - Fax:787-892-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTIN
PR20970Medicare ID - Type UnspecifiedPROVIDER NUMBER