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General NPI Number Information
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NPI Number | 1174521827
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Entity Type | Organization
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Legal Business Name | RM DENTAL PRACTICE PSC
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | URB LOMAS VERDES Z-30 AVE LAUREL
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-787-2384
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Fax | 787-740-0035
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Provider Business Mailing Address
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Address Line | URB LOMAS VERDES Z-30 AVE LAUREL
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-787-2384
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Fax | 787-740-0035
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Authorized Official
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Title or Position | PRESIDENT
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Name | HERIBERTO J MONTALVO
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Credential | D.M.D.
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Telephone | 787-787-2384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1258
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1159
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License Number State | PR
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