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General NPI Number Information
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NPI Number | 1457487308
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Entity Type | Individual
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Provider Name | MARIA IVELISSE BERRIOS DMD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 11/03/2017
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Provider Practice Location Address
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Address Line | WINSTON CHURCHILL AVENUE APT 811 COND VILLAS DEL SENORIAL
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City | SAN JUAN
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State | PR
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Zip | 00926-6711
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Country | US
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Telephone | 787-559-9121
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Fax |
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Provider Business Mailing Address
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Address Line | COND. VILLAS DEL SENORIAL W.CHURCHILL AVE. APT #811
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-559-9121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN20312
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License Number State | FL
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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 | 2674
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License Number State | PR
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