Healthcare Provider Details

I. General information

NPI: 1740277938
Provider Name (Legal Business Name): FRANCISCO L. BERMUDEZ D.M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
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 P.O. BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-4646
  • Fax: 787-641-4644
Mailing address:
  • Phone: 787-641-4646
  • Fax: 787-641-4644

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:
Title or Position:
Credential:
Phone: