Healthcare Provider Details

I. General information

NPI: 1316697402
Provider Name (Legal Business Name): VRM PROSTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 167 URB MONTANEZ NUM 11
BAYAMON PR
00957
US

IV. Provider business mailing address

675 SERGIO CUEVAS BUSTAMANTE APT 1504
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-7900
  • Fax:
Mailing address:
  • Phone: 787-613-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: VICTOR A RIVERA
Title or Position: PRESIDENT
Credential: DMD,MS
Phone: 787-613-0433