Carmen Ofelia De Jesus, DMD
Individual provider Active NPI General Practice Dentistry · Santurce, PR
NPI 1295887925 · NPPES record last updated Aug 28, 2014
Key facts
- NPI
- 1295887925
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1713 (PR)
- Practice address
- Edif Centro Europa Ste 715
1492 Ave Ponce de Leon, Pda. 22
Santurce, PR 00907-4012 - Phone
- (787) 781-3545
- Fax
- (787) 781-2587
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|---|
| I20160204001334 | PR | Order and Referring Only - Oral Surgery |
8729382106 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1713 | PR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Image Diagnostic PSC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1713 | PR | Yes |
Addresses
Primary practice location
Edif Centro Europa Ste 715
1492 Ave Ponce de Leon, Pda. 22
Santurce, PR 00907-4012
Mailing address
PO Box 363216
San Juan, PR 00936-3216
Phone (787) 781-3545
Other providers in Santurce, PR
- Karyna Limary Cruz
- Norma I. Cruz
- Rosa Ileana Cruz
- Damar of Puerto Rico Services Inc
- Damar of Puerto Rico Services, Inc.
- Roselania De la Rosa
- Sylvia De Mercado
- Francisco R De Torres Sr.
- Laura J Delcarmen Rivera
- Milton Oscar Delgado Mejias
All providers in Santurce, 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 Aug 28, 2014. 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.