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General NPI Number Information
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NPI Number | 1366621757
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Entity Type | Organization
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Legal Business Name | BDH PROFESSIONAL DENTAL GROUP PSC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | CALLE CESAR GONZALEZ # 576 DORAL BANK CENTER, SUITE 407
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City | SAN JUAN
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State | PR
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Zip | 00918-3901
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Country | US
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Telephone | 787-282-0709
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE CESAR GONZALEZ # 576 DORAL BANK CENTER, SUITE 407
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City | SAN JUAN
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State | PR
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Zip | 00918-3901
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Country | US
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Telephone | 787-282-0709
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Fax |
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Authorized Official
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Title or Position | DMD
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Name | DR. RONALDO BERDECIA
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Credential |
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Telephone | 787-282-0709
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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 | 2089
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License Number State | PR
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