Provider Demographics
NPI:1063530111
Name:CLINICA DENTAL MIRMAR INC
Entity type:Organization
Organization Name:CLINICA DENTAL MIRMAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRELIS
Authorized Official - Middle Name:NYVETTE
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-247-5851
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0165
Mailing Address - Country:US
Mailing Address - Phone:787-869-2565
Mailing Address - Fax:787-869-2471
Practice Address - Street 1:120 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3011
Practice Address - Country:US
Practice Address - Phone:787-869-2565
Practice Address - Fax:787-869-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2675261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental