Edda Liz Bautista Perez, D.M.D
Individual provider Active NPI General Practice Dentistry · Juncos, PR
NPI 1043218183 · NPPES record last updated Jul 2, 2019
Key facts
- NPI
- 1043218183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2438 (PR)
- Practice address
- Calle Munoz Rivera #65
Juncos, PR 00777 - Phone
- (787) 713-9788
- NPI assigned
- Jul 12, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150902000915 | PR | Order and Referring Only - Oral Surgery |
3678889813 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2438 | PR | MD | General Practice Dentistry |
| 34839 | TX | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34839 | TX | |
| General Practice Dentistry | 1223G0001X | 2438 | PR | Yes |
Addresses
Primary practice location
Calle Munoz Rivera #65
Juncos, PR 00777
Mailing address
PO Box 1802
Juncos, PR 00777-1802
Phone (787) 713-9788
Other practice location 1
1173 Edgebrook Dr Ste B
Houston, TX 77034-1862
Phone (787) 608-9626
Other providers in Juncos, PR
- Rafael J Arthur-Nouel
- Atlantis Health Care Group Puerto Rico, Inc.
- Autentic Sunglasess & Optical
- Arindoramis Lorein Ayala Carrasquillo
- Wilson Batista
- Nannette Berrios
- Edith Rose Bezares
- Bravo Dental LLC
- Ricardo A Bravo
- Ricardo J Bravo
All providers in Juncos, PR · General Practice Dentistry in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.