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General NPI Number Information
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NPI Number | 1376897892
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Entity Type | Organization
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Legal Business Name | CMR DENTAL GROUP, P.S.C.
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | AVE. ESMERALDA #6 URB. PONCE DE LEON
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City | GUAYNABO
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State | PR
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Zip | 00969-4280
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Country | US
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Telephone | 787-756-8491
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Fax |
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Provider Business Mailing Address
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Address Line | AVE. ESMERALDA #6 URB. PONCE DE LEON
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City | GUAYNABO
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State | PR
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Zip | 00969-4280
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Country | US
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Telephone | 787-756-8491
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MRS. CARMEN MYRIAM RIVERA
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Credential | DMD
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Telephone | 787-756-8491
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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 | 1312
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License Number State | PR
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