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NPI Code Detail

MEDICARE: DR. ELLIOTT BERMUDEZ-COLON DDS

MEDICARE:  DR. ELLIOTT  BERMUDEZ-COLON  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2118PR
21223P0300XPeriodontics2118PR

General Provider Information

NPI Number : 1215032057
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLIOTT BERMUDEZ-COLON DDS
Provider Business Mailing Address
First Line : 8322 MOJAVE RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78254-2139
Country : US
Telephone Number : 210-643-0070
Fax Number :
Provider Business Practice Location Address
First Line : 2940 STANLEY RD STE 2375
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234-2740
Country : US
Telephone Number : 210-295-4595
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 05/05/2023

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Directions to “ DR. ELLIOTT BERMUDEZ-COLON DDS” Practice Location

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