Provider Demographics
NPI:1578395448
Name:BOUTIQUE DENTAL BAYAMON
Entity type:Organization
Organization Name:BOUTIQUE DENTAL BAYAMON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:IRMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-799-5052
Mailing Address - Street 1:URB ROYAL TOWN
Mailing Address - Street 2:AVE LAS CUMBRES A20
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-428-6363
Mailing Address - Fax:
Practice Address - Street 1:INTERSECCION 696 Y CALLE FELICITA RINCON DE GAUTIER
Practice Address - Street 2:BO HIGUILLAR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-428-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty