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General NPI Number Information
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NPI Number | 1063530111
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Entity Type | Organization
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Legal Business Name | CLINICA DENTAL MIRMAR INC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 CALLE GEORGETTI
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City | NARANJITO
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State | PR
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Zip | 00719-3011
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Country | US
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Telephone | 787-869-2565
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Fax | 787-869-2471
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Provider Business Mailing Address
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Address Line | PO BOX 165
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City | NARANJITO
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State | PR
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Zip | 00719-0165
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Country | US
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Telephone | 787-869-2565
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Fax | 787-869-2471
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIRELIS NYVETTE COLON
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Credential | D.M.D.
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Telephone | 787-247-5851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2675
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License Number State | PR
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