Provider Demographics
NPI:1992120612
Name:BURGOS, KRISTEL (DMD)
Entity type:Individual
Prefix:
First Name:KRISTEL
Middle Name:
Last Name:BURGOS
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:KRISTEL
Other - Middle Name:
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 10818
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0818
Mailing Address - Country:US
Mailing Address - Phone:609-287-0676
Mailing Address - Fax:
Practice Address - Street 1:PR 172 INT PR 1 PLAZA DEL CARMEN MALL SUITE 22
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:609-287-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34921223E0200X
NY0582151223G0001X, 1223E0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program