Provider Demographics
NPI:1063759280
Name:DENTAL PMB, P.C.
Entity type:Organization
Organization Name:DENTAL PMB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORBERTO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:PLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-686-4140
Mailing Address - Street 1:2 CALLE M
Mailing Address - Street 2:URB SAN CRISTOBAL
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1924
Mailing Address - Country:US
Mailing Address - Phone:347-686-4140
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE M
Practice Address - Street 2:URB SAN CRISTOBAL
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1924
Practice Address - Country:US
Practice Address - Phone:347-686-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty