Individual provider Active NPI

Juan Carlos Pagan, D.M.D.

  • General Practice Dentistry
  • San Juan, PR
National Provider Identifier
1053406637
Registry record updated Jul 8, 2007
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2221 Issued in PR
Practice address
166 Winston Churchill Ave
San Juan, PR 00926
Phone
(787) 759-6972
Fax
(787) 763-4758
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2221 PR Primary

Addresses

Primary practice location

166 Winston Churchill Ave
San Juan, PR 00926

Mailing address

300 La Sierra Ave
Box 65
San Juan, PR 00926
Phone (787) 759-6972

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240109001626 PR Order and Referring Only - DentistPractitioner - Dentist 4789998444

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053406637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LA SIERRA AVE",
            "address_2": "BOX 65",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-759-6972",
            "fax_number": "787-763-4758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 WINSTON CHURCHILL AVE",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-759-6972",
            "fax_number": "787-763-4758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGAN",
        "first_name": "JUAN",
        "middle_name": "CARLOS",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "2221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.