Provider Demographics
NPI:1841484573
Name:KM DENTAL, C.S.P.
Entity type:Organization
Organization Name:KM DENTAL, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-731-2261
Mailing Address - Street 1:#1 AVE. PALMA REAL APT. 1411
Mailing Address - Street 2:MURANO LUXURY APARTMENTS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-731-2261
Mailing Address - Fax:787-731-2261
Practice Address - Street 1:576 AVE. CESAR GONZALEZ
Practice Address - Street 2:DORAL BANK CENTER OFIC. 307
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-753-1475
Practice Address - Fax:787-731-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2697261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental