Provider Demographics
NPI:1861413031
Name:CEIDE, MYRNA JUDITH (DDS)
Entity type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:JUDITH
Last Name:CEIDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0557
Mailing Address - Country:US
Mailing Address - Phone:787-464-6500
Mailing Address - Fax:787-254-6107
Practice Address - Street 1:85 CALLE CARBONELL
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3443
Practice Address - Country:US
Practice Address - Phone:787-254-6107
Practice Address - Fax:787-254-6107
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist