Provider Demographics
NPI:1699747345
Name:LEGRAND FLORES, MAYRA MILAGROS (DMD)
Entity type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:MILAGROS
Last Name:LEGRAND FLORES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B18 CALLE SAN BARTOLOME
Mailing Address - Street 2:URB. NOTRE DAME
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3924
Mailing Address - Country:US
Mailing Address - Phone:787-778-6349
Mailing Address - Fax:787-780-5592
Practice Address - Street 1:AVE. TENIENTE N. MARTINEZ L17
Practice Address - Street 2:URB. ALTURAS DE FLAMBOYAN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6565
Practice Address - Country:US
Practice Address - Phone:787-778-6349
Practice Address - Fax:787-780-5592
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR42377OtherTRIPLE S