Healthcare Provider Details

I. General information

NPI: 1003897521
Provider Name (Legal Business Name): EDGAR A. BELARDO MARRERO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA REAL SHOPPING CENTER SUITE 308 AVE. ALBOLOTE 1
GUAYNABO PR
00969-2807
US

IV. Provider business mailing address

PLAZA REAL SHOPPING CENTER SUITE 308 AVE. ALBOLOTE 1
GUAYNABO PR
00969-2807
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-0273
  • Fax: 787-641-0275
Mailing address:
  • Phone: 787-641-0273
  • Fax: 787-641-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number048189
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2760
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: