NPIMap

Organization Active NPI

Idental Center, Professional Dentistry, CSP

  • General Practice Dentistry
  • Yabucoa, PR
National Provider Identifier
1225161854
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2680 Issued in PR
Legal business name
IDENTAL CENTER, PROFESSIONAL DENTISTRY, CSP
Practice address
Urbanizacion Villa Hilda
A5 Street 1
Yabucoa, PR 00767
Phone
(787) 266-3140
Fax
(787) 893-3922
NPI assigned
Mar 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Mayra Cristina Gomez, DMDNPI 1609941822
Title
President
Phone
(787) 266-3140

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2680 PR Primary

Addresses

Primary practice location

Urbanizacion Villa Hilda
A5 Street 1
Yabucoa, PR 00767

Mailing address

PO Box 1198
Las Piedras, PR 00771-1198
Phone (787) 266-3140

National Provider Directory

National Provider Directory
Tax ID family
Idental Center PSC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225161854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1198",
            "city": "LAS PIEDRAS",
            "state": "PR",
            "postal_code": "007711198",
            "telephone_number": "787-266-3140",
            "fax_number": "787-893-3922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "URBANIZACION VILLA HILDA",
            "address_2": "A5 STREET 1",
            "city": "YABUCOA",
            "state": "PR",
            "postal_code": "00767",
            "telephone_number": "787-266-3140",
            "fax_number": "787-893-3922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTAL CENTER, PROFESSIONAL DENTISTRY, CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_middle_name": "CRISTINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-266-3140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "2680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yabucoa, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.