Healthcare Provider Details

I. General information

NPI: 1174521827
Provider Name (Legal Business Name): RM DENTAL PRACTICE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB LOMAS VERDES Z-30 AVE LAUREL
BAYAMON PR
00956
US

IV. Provider business mailing address

URB LOMAS VERDES Z-30 AVE LAUREL
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-2384
  • Fax: 787-740-0035
Mailing address:
  • Phone: 787-787-2384
  • Fax: 787-740-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1258
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1159
License Number StatePR

VIII. Authorized Official

Name: HERIBERTO J MONTALVO
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 787-787-2384