Provider Demographics
NPI:1699432013
Name:PRO MEDICAL DENTAL GROUP LLC
Entity type:Organization
Organization Name:PRO MEDICAL DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACTURADORA
Authorized Official - Prefix:
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TORRES CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-955-2901
Mailing Address - Street 1:403 CALLE FLAMBOYAN
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 924 KM 3.3 BARRIO PITAHAYA
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-955-2901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center