Healthcare Provider Details

I. General information

NPI: 1699074039
Provider Name (Legal Business Name): GNATHOS SURGICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 305 CAROLINA SHOPPING COURT
CAROLINA PR
00985
US

IV. Provider business mailing address

PMB 209 PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-4646
  • Fax: 787-750-4646
Mailing address:
  • Phone: 787-641-4646
  • Fax: 787-750-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2070
License Number StatePR

VIII. Authorized Official

Name: DR. FRANCISCO L BERMUDEZ
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 787-237-4418