Healthcare Provider Details

I. General information

NPI: 1770498248
Provider Name (Legal Business Name): KIP ORAL & MAXILLOFACIAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CALLE DR NELSON PEREA STE 205
MAYAGUEZ PR
00680-4970
US

IV. Provider business mailing address

27 CALLE DR NELSON PEREA STE 205
MAYAGUEZ PR
00680-4970
US

V. Phone/Fax

Practice location:
  • Phone: 917-705-2383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KENDRA IRIZARRY PAGAN
Title or Position: OWNER
Credential: DMD
Phone: 917-705-2383