Healthcare Provider Details

I. General information

NPI: 1851019681
Provider Name (Legal Business Name): MIO DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CALLE AMISTAD
LAJAS PR
00667-2060
US

IV. Provider business mailing address

5 ERLICH CT
LAJAS PR
00667-2614
US

V. Phone/Fax

Practice location:
  • Phone: 787-384-2505
  • Fax:
Mailing address:
  • Phone: 787-384-2505
  • 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: MARIA P IRIZARRY
Title or Position: DMD
Credential:
Phone: 787-384-2505