Provider Demographics
NPI:1235936550
Name:BURGOS DENTAL GROUP LLC
Entity type:Organization
Organization Name:BURGOS DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-246-8000
Mailing Address - Street 1:PO BOX 10818
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PR-172 INT. PR-1
Practice Address - Street 2:PLAZA DEL CARMEN MALL, SUITE 22
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-745-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty