Healthcare Provider Details

I. General information

NPI: 1528988490
Provider Name (Legal Business Name): BAYAMON DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB MIRAFLORES AVE LOS DOMINICOS #8
BAYAMON PR
00957
US

IV. Provider business mailing address

400 AVE FD ROOSEVELT STE 505
SAN JUAN PR
00918-2163
US

V. Phone/Fax

Practice location:
  • Phone: 787-799-4116
  • Fax:
Mailing address:
  • Phone: 787-799-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS LIONEL MARTINEZ PEREZ
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-608-6521