Healthcare Provider Details

I. General information

NPI: 1003721275
Provider Name (Legal Business Name): BELLA SONRISA PR DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 PR 2 METRO MEDICAL CENTER A 601
BAYAMON PR
00959
US

IV. Provider business mailing address

BB12 CALLE C
BAYAMON PR
00957-2467
US

V. Phone/Fax

Practice location:
  • Phone: 787-409-4295
  • Fax:
Mailing address:
  • Phone: 787-409-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CARLOS A IZCOA FLORES
Title or Position: PRESIDENTE
Credential: DMD
Phone: 787-409-4295