Provider Demographics
NPI:1366621757
Name:BDH PROFESSIONAL DENTAL GROUP PSC
Entity type:Organization
Organization Name:BDH PROFESSIONAL DENTAL GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDECIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-282-0709
Mailing Address - Street 1:CALLE CESAR GONZALEZ # 576
Mailing Address - Street 2:DORAL BANK CENTER, SUITE 407
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3901
Mailing Address - Country:US
Mailing Address - Phone:787-282-0709
Mailing Address - Fax:
Practice Address - Street 1:CALLE CESAR GONZALEZ # 576
Practice Address - Street 2:DORAL BANK CENTER, SUITE 407
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3901
Practice Address - Country:US
Practice Address - Phone:787-282-0709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2089261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental