Provider Demographics
NPI:1588445571
Name:MPB DENTAL LLC
Entity type:Organization
Organization Name:MPB DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-DMD
Authorized Official - Prefix:
Authorized Official - First Name:MARGIEZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-548-6158
Mailing Address - Street 1:GALERIA PROFESIONAL CALLE CONCORDIA 8118
Mailing Address - Street 2:OFICINA 107
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-843-4465
Mailing Address - Fax:
Practice Address - Street 1:GALERIA PROFESIONAL CALLE CONCORDIA 8118
Practice Address - Street 2:OFICINA 107
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-843-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty