Healthcare Provider Details

I. General information

NPI: 1699579383
Provider Name (Legal Business Name): CES DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO DAJAOS, CARR 167 KM 11
BAYAMON PR
00956
US

IV. Provider business mailing address

BOSQUES DE LAS PALMAS 247 CALLE REAL
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-449-3449
  • Fax:
Mailing address:
  • Phone: 787-449-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA SANTIAGO
Title or Position: DENTISTA
Credential: DMD
Phone: 787-449-3449