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General NPI Number Information
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NPI Number | 1245899293
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Entity Type | Organization
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Legal Business Name | VP PERIO LLC
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | CARR 693 INT 659 KM 1.5 BO MAGUAYO SUITE B240
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-934-5970
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 AVE MAGDALENA APT C12
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City | SAN JUAN
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State | PR
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Zip | 00907-1953
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Country | US
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Telephone | 787-934-5970
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. VIRMARIS L PERDOMO
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Credential | DMD
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Telephone | 787-934-5970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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