Healthcare Provider Details

I. General information

NPI: 1346957396
Provider Name (Legal Business Name): CUPEY DENTAL GALLERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. SAN CLAUDIO 390 URB. SAGRADO CORAZON
SAN JUAN PR
00926-0092
US

IV. Provider business mailing address

HC 67 BOX 15090
BAYAMON PR
00956-9510
US

V. Phone/Fax

Practice location:
  • Phone: 787-748-2025
  • Fax:
Mailing address:
  • Phone: 787-664-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DENISHA BERRIOS
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 787-664-0935