=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528988490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYAMON DENTAL GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2026
-----------------------------------------------------
Last Update Date | 07/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB MIRAFLORES AVE LOS DOMINICOS #8
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-799-4116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 AVE FD ROOSEVELT STE 505
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-2163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-799-4116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CARLOS LIONEL MARTINEZ PEREZ
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 787-608-6521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------