Provider Demographics
NPI:1043045602
Name:BURGOS DENTAL LLC
Entity type:Organization
Organization Name:BURGOS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-202-5881
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-0776
Mailing Address - Country:US
Mailing Address - Phone:787-866-5227
Mailing Address - Fax:
Practice Address - Street 1:36 ABRAHAM PENA & CARRION MADURO STS.
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-866-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental